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Treating Endometriosis: Pain, Cure and Medications

By Dr. Dinesh Kansal in Centre for Women Health

Mar 24 , 2023 | 4 min read

Endometriosis: Symptoms and Causes

Endometriosis is a dreadful disorder characterised by the growth of endometrial-like tissue outside of the uterine cavity. The tissue may grow over ovaries, bowel, fallopian tubes and tissue lining the pelvis. The name is given from the word endometrium, the tissue which lines the uterus or womb. In this condition, the endometrial-like tissue thickens, sheds off and bleeds with each period cycle. However, the tissue gets trapped being unable to exit the body. This may result in intenseendometriosis pain, especially during menstrual cycles. Some other symptoms include bleeding and spotting, infertility, and stomach problems. Researchers are trying hard to find the potential causes of the disease. Some of the possible causes may involve a faulty immune system, retrograde menstrual flow, higher estrogen or genetic factors. Endometriosis is most prevalent among women aged between 30 and 40 years making it difficult for them to conceive at times. However, several medications for endometriosis and treatment options are available which can help in managing symptoms.

Key Factors Determining Endometriosis

Research shows that Endometriosis may develop when :
  • A family member like a mother or sister has the same condition
  • An abnormal Uterus.
  • Early menstruation and shorter period cycles of less than 27 days
  • Heavy menstrual periods continuing for more than 7 days

How to Treat Endometriosis With Medication?

Treatment for endometriosis is done either by medicines or surgical procedures. Doctors choose the right method of treatment depending on the severity of the symptoms. Therapies used for treating endometriosis include :

Nsaids & Cox-2 Inhibitors

NSAIDS especially Naproxen is effective in reducing endometriosis pain. COX-2 inhibitors eg: Valdecoxib are more effective in dysmenorrhea. NICE recommends 3 months trial of NSAIDS.

Birth Control Hormonal Contraceptives

Medication for endometriosis includes these pills that control the hormones building up endometrial tissue. The pills are composed of synthetic progesterone (progestins) and are effective for endometriosis. Women experience painless menstrual cycles with these pills along with the lighter menstrual flow.

Hormonal IUD

Hormonal Intrauterine devices (IUD), namely MIRENA reduce the hormone production that regulates ovulation and periods thus controlling endometriosis. The growth of endometrial-like tissue outside the uterus is decreased with shorter and lighter periods.

Gn-RH (Gonadotropin-releasing Hormone) Agonists and Antagonists

Medication for endometriosisinvolves this group of drugs that prevents menstruation by blocking the synthesis of ovarian-stimulating hormones. This can lower estrogen levels and shrink endometrial tissue. The most commonly used amongst this category is Inj Leuprolide depot 11.25 mg.

Danazol

Endometriosis curecan be achieved by this group of synthetic steroids. Danazol suppresses ovarian function through a direct repressive effect on ovarian steroidogenesis. Read more: EndometrialCancer Treatment in Delhi

Surgical Procedures

Laparoscopy

A minimally invasive surgical method to treat endometriosis is laparoscopy. This procedure involves the insertion of a slender viewing device (laparoscope) by making a small incision in the abdomen. This helps the doctor to view the tissues around the uterus and check for endometrial tissue growth. By executing laparoscopy, one can get information about the location, size and extent of endometrial implants.

Advantages

  • Better visualization of subtle lesions, less tissue trauma, adhesiolysis, restoring tubo ovarian anatomy, excision of visible lesions, staging of endometriosis, smaller incisions as compared to open surgery, speedy recovery and less post-operative adhesions and complications.
  • It works on the principle of “See & Treat”, diagnosis can be confirmed and treatment can be carried out at the same time.
  • Visual inspection of the pelvis as laparoscopy is the gold standard investigation
  • Laparoscopic aspiration, irrigation and vapourisation of the cyst wall are not recommended to destroy the mucosal lining.
  • Instead, excision of the capsule instead of drainage and electrocoagulation of the endometrioma wall is done ideally. As it reduced recurrence, provides better pain relief and provides the histological diagnosis.

Oophorectomy

Doctors may recommend removing ovaries along with hysterectomy by a process called oophorectomy. This results in substantially lower estrogen levels and inhibited endometrial tissue growth. This is beneficial in Deep infiltrating endometriosis and severe cases. Total hysterectomy with removal of all visible endometriotic tissue with bilateral Oopherectomy results in improved pain and reduces chances of future surgery. However, along with these two procedures, some side effects like heart disease, bone loss or depression and anxiety may come up in patients.

Infertility Treatment

An Innovation in women's health science has come up in the form of Restorative reproductive medicine or RRM. This infertility treatment not only restores women's reproductive health and well-being but also maintains and improves gynaecological health conditions. RRM offers medical and surgical treatments and solves the root causes of reproductive disorders, thus enhancing natural fertility.

Fertility drugs and IUI

Fertility drugs facilitate ovulation by stimulating the pituitary gland to release more follicle-stimulating hormone and luteinizing hormone. On the other hand, intrauterineinsemination(IUI) is a form of artificial insemination totreat infertility. Washed and concentrated sperm are placed in the uterus around the time of ovulation for better fertilization.

In Vitro Fertilization (IVF)

During theIVF process, mature eggs from the ovaries are collected and fertilized in aseptic conditions that help in child conception.


Takeaway

According to reports from the Endometriosis Society of India, 25 million Indian women are affected by this condition. However, this disease is seldom understood and discussed due to various taboos around menstruation. Proper knowledge and treatment can better cure the disease and make women free from Endometriosis.