Medical Management of EndometriosisDr Chinmayie R
Endometriosis can be treated with medications and surgery. The approach chosen will depend on the severity of the signs and symptoms and whether the patient is planning for pregnancy or not.
Medications for Treating Endometriosis
Doctors may recommend an over-the-counter pain reliever, such as Non-steroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen or naproxen to help ease painful menstrual cramps. However, these pain-relieving medications do not affect the endometrial implants or the regression of endometriosis. If these pain medications are ineffective, additional evaluation and treatment will be necessary.
Supplemental hormones are sometimes effective in reducing or eliminating endometriosis pain. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new endometrial tissue implants. Hormone therapy isn’t a permanent solution for endometriosis. Patients may experience a return of the symptoms after stopping treatment.
Therapies used to treat endometriosis include:
1. Hormonal Contraceptives
Birth control pills, patches, and vaginal rings help control the hormones responsible for the build-up of endometrial tissue each month. Using hormonal contraceptives – especially continuous cycle regimens – may reduce or eliminate the pain of mild to moderate endometriosis. Most patients have lighter and shorter menstrual flow when using a hormonal contraceptive. Occasionally, weight gain, breast tenderness, nausea, and irregular bleeding may occur. Oral contraceptive pills are usually well-tolerated in women with endometriosis.
2. Gonadotropin-Releasing Hormone (Gn-RH) Agonists and Antagonists
These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these drugs create an artificial menopause, it causes side effects like:
• Hot flashes
• Vaginal dryness
• Irregular vaginal bleeding
• Mood alterations
• Fatigue and
• Loss of bone density (osteoporosis)
Taking a low dose of estrogen or progestin (“Add Back Therapy”) along with Gn-RH agonists may decrease menopausal side effects. The patient’s periods and her ability to get pregnant will stop the medication.
3. Progestin Therapy
A progestin-only contraceptive, such as an intrauterine device (Mirena), contraceptive implant, or contraceptive injection (Depo-Provera), can halt menstrual periods and grow endometrial implants, which may relieve endometriosis signs and symptoms.
This drug suppresses the growth of the endometrium by blocking the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis. Eighty per cent of women who take this drug will have pain relief and shrinkage of endometriosis implants, but up to 75% of women develop significant side effects from the medication. These include:
• Weight gain
• Edema (swelling)
• Breast shrinkage
• Oily skin
• Hirsutism (male pattern hair growth)
• Deepening of the voice
• Hot flashes
• Changes in libido
• Mood alterations
• And can be harmful to the baby if you become pregnant while taking this medication
5. Aromatase Inhibitors
More current treatment of endometriosis has involved administering aromatase inhibitors (for example, anastrozole and letrozole). These drugs act by interrupting local estrogen formation within the endometriosis implants themselves. They also inhibit estrogen production within the ovary and adipose tissue. Aromatase inhibitors can cause significant bone loss with prolonged usage.