| Contents: NSAIDS
Estrogen-Progesterone
Danazol
GnRH agonist
Surgery
Traditional Western
medicine tend to treat endometriosis with medications or surgery. All of
the pharmacological treatments are by no means a "cure" for
endometriosis, but rather help to alleviate its symptoms. Surgery is not
always a curative measure either. If a woman's ovaries are left in place
at the time of hysterectomy, the ovaries will continue to produce estrogen,
stimulating the extrauterine foci of endometrial tissue. For many, surgery
is a last ditch effort to gain relief from the pain--despite significant risks
that accompany general anesthesia and the surgery itself. It is because of
these risks that many women opt for alternative treatments, or pharmacological
therapies.
 NSAIDS
Nonsteriodal anti-inflammatory drugs, such
as ibuprofen, are commonly used to alleviate cramping and discomfort associated
with endometriosis. These drugs block a crucial step in the
inflammatory pathway, which blocks the production of prostaglandins. These
are available without a prescription, but are not always strong enough to
alleviate intense cramping. This therapy does not cure the endometriosis,
but simply alleviates some of the symptoms.
 ESTROGEN-PROGESTERONE
Birth control pills are commonly used to
help prevent some of the discomfort experienced during menstruation. Oral
contraceptives contain synthetic estrogens (ethinyl estradiol is most common)
which act to suppress ovulation. With the onset of menstruation, formed
prostaglandins are released from the shedding endometrium
which can stimulate
uterine contraction and cramping. However, birth control pills result in a
thin endometrium with decreased bleeding, thus decreasing the amount of
prostaglandin that is released. Another hormone option is Depo-Provera injections.
Depo-Provera suppresses ovulation by inhibiting the surge of a hormone called luteinizing hormone. However, symptoms usually recur within 6-12 months after discontinuation of both
oral and injection contraceptives. This therapy does not cure
endometriosis, but simply alleviates some of the symptoms.
 DANAZOL
Danazol is a derivative of a synthetic
steroid. Its action on the body is to eliminate midcycle surge of FSH and
LH, and therefore, ovulation. It creates a high androgen, low estrogen
state. It has been associated with significant improvements in dysmenorrhea,
dyspareunia, and other menstrual pain. However, the side
effects are generally not well tolerated, they include: weight gain, acne,
hirsuitism, hot flashes, decreased breast size, fatigue, vaginal atrophy, and
emotional lability. Pain tends to recur within 6 months after
discontinuing therapy. This therapy does not cure endometriosis, but
simply alleviates some of the symptoms.
 GnRH
AGONIST
The newest medications used for treating
endometriosis are the gonadotropin-releasing hormone agonist (Lupron, Zolzdex,
Synarel). GnRH agonists essentially cause complete suppression of the
menstrual cycle, thereby removing the stimulatory effect of estrogen, leading to
decrease inflammation and pain. Significant results have been obtained
with the GnRH agonists, most women have a large reduction dysmenorrhea,
dyspareunia, and back pain associated with endometriosis. Unfortunately,
these agonists send a person's body into a "pseudomenopause," complete
with hot flashes. Women may usually experience mood lability, vaginal
atrophy, and vasomotor changes (hot flashes). However, of more concern is
the drug's affect on bone metabolism and increased serum lipids. After 6
months of therapy, there seems to be increased bone loss in women using the
agonists, and therefore therapy cannot persist beyond the 6 months. There
also seems to be an elevation of LDL ("bad cholesterol") with
long-term use of GnRH agonists. With cessation of therapy, symptoms will
return anywhere between 3-12 months. This therapy does not cure
endometriosis, but simply alleviates some of the symptoms.
Interestingly, there are now new studies out that
support the use of GnRH agonists in conjunction with add-back therapy.
This add-back therapy can be likened to hormone replacement therapy in
menopausal women. The doses of estrogen and progesterone are not enough to
exacerbate the endometriosis, but studies have shown that there is less bone
loss with the add-back therapy. For more information on add-back therapy,
please see reference article by Eric Surrey, MD.
 SURGERY
There are a few approaches to surgical treatment
of endometriosis. As with any type of surgery, there are risks associated
with general anesthesia. It should be kept in mind, that as long at the
ovaries are still in the body and producing estrogen, a women will continue to
have problems with endometriosis. Even if a woman has a hysterectomy
(removal of the uterus), her ovaries will continue to produce estrogen which
will stimulate the extrauterine foci of endometriosis. The following are
the surgical options for endometriosis:
- Laparoscopy with coagulation of superficial
lesions
- Conservative surgery--deep dissection and
resection of all identifiable lesions
- Semi-conservative surgery entails hysterectomy
with preservation of ovaries
- Radical surgery entails a total abdominal
hysterectomy with a bilateral salpingo-oophorectomy (removal of tubes and
ovaries)
- Definitive surgery includes a total abdominal hysterectomy
with bilateral salpingo-oophorectomy, resection of all palpable and visible
lesions on bowel, bladder, pelvic wall.
 Take
Home Message
*NSAIDS are good for temporary pain
relief
*Birth control pills may
decrease monthly pain and bleeding
*Danazol provides good pain
relief, but symptoms return;
horrible side effects
*GnRH agonists provide
excellent relief of dysmenorrhea,
dyspareunia, and bowel symptoms--but return within
months
following discontinuation. Horrible side effects
*Surgery does not always cure
endometriosis, and has added risks
due
to general
anesthesia and surgery itself.
 
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