When a diagnosis of endometriosis is made, treatment options include taking a "wait and see" approach to determine if your symptoms get better or worse (often with the use of an over-the-counter pain reliever), prescription drug therapy, surgery, or a combination of prescription drug therapy and surgery. Your doctor will talk to you in more detail about your treatment choices.
Women who wish to become pregnant and who have mild symptoms of disease that are controlled with pain relievers, are recommended to begin attempting to become pregnant for a period of six months to one year. If pregnancy does not occur during that time, other treatment options will be discussed based on an individual’s case history.
Prescription Drug Therapy for Endometriosis
Several drug treatment options are available for women who do not wish to become pregnant (or do not wish to become pregnant right away) but who need pain management that is not controlled with over-the-counter medications.
- Gonadotropin-releasing hormone agonist (GnRH agonist). This category of drug, also called a synthetic pituitary hormone blocker, stops the production of estrogen by blocking pituitary gland hormones that stimulate the ovaries. Because this therapy stops ovulation, women who take it will not get pregnant. Pain is relieved because estrogen that normally stimulates the growth of endometrial tissue is being made at very low levels. This therapy is most effective when excess endometrial tissue is small.
One drawback to this therapy is the potential for bone loss because of the interruption in the production of estrogen. Women also may experience other menopausal-like symptoms while taking a GnRH agonist, such as hot flashes, vaginal dryness, mood changes and sleep disturbances. These side effects go away once drug therapy is stopped.
One form of this drug includes nafarelin acetate (Synarel), a nasal spray that was found to be comparable to danazol (described below) in relieving pain and the growth of endometrial tissue. Side effects include non-menstrual bleeding, ovarian cysts during the first two months of use, headache, hot flashes, vaginal dryness, decreased sex drive and nasal irritation.
Other forms of GnRH agonists that are similar in effectiveness (and side effects) to nafarelin acetate include leuprolide acetate (Lupron), which is injected once a month into muscle, and goserelin acetate implant (Zoladex), which is injected under the skin in the abdomen.
- Danazol (or Danocrine, a synthetic male hormone similar to testosterone). This drug has been remarkably effective in treating the pain of endometriosis. An estimated 80-90 percent of women who take it find relief of symptoms and a regression in the size of excess endometrial tissue. However, the drug can have uncomfortable side effects, including hot flashes, acne, voice change, excessive hair growth and fluid retention. These side effects cease once the drug is stopped.
Women of childbearing age must take precautions to avoid a pregnancy while on danazol, as the drug may cause birth defects.
- Oral contraceptives. Your doctor may prescribe birth control pills for temporary relief of pain. The synthetic estrogen and progesterone in these pills stops ovulation, thus reducing menstruation and cramps. However, they may not be effective in reducing pain long term.
Surgery Options for Endometriosis
For some women with severe endometriosis, laparoscopic surgery to remove excess tissue may be recommended. This procedure also may take place during diagnostic laparoscopy so that the diagnosis and treatment phases are performed at the same time.
When surgery is performed at the time of diagnosis, your doctor may remove the excess endometrial tissue by cutting and cauterizing it with a laser or with electrocautery. The laser or the electrocautery device is inserted through the laparoscope. One clinical study found that 65 percent of women who had undergone surgery with laser laparoscopy continued to have pain relief six months after their treatment. Recovery time after surgery is about one week.
In other situations following diagnostic laparoscopy — for example, when your doctor is not able to view all of the endometrial tissue with laparoscopy — open surgery, or laparotomy, may be recommended. This procedure is performed in the hospital operating room under a general anesthetic. During this procedure, your surgeon will make an incision to open your abdomen, which then allows him or her to view your internal organs and remove excess tissue. The operation usually takes about two hours, but will depend primarily on the severity of the disease and on the amount of tissue that is being removed. Recovery time after surgery is about four to six weeks.
Depending on the extent of surgery, women who wish to become pregnant may need to take fertility drugs or explore the option of in vitro fertilization.
Return of Symptoms for Endometriosis
Unfortunately, the disease is such that in severe cases of endometriosis, the endometrial tissue, and the pain, returns even after surgery. Additionally, women who use hormone replacement therapy (estrogen/progesterone) during menopause also may see a return of their symptoms. This rare occurrence happens because estrogen stimulates endometrial tissue.
In these situations, treatment with prescription drug therapy, including a hormone suppression drug, birth control pills or a synthetic male hormone may be recommended. (Prescription drug therapy) In women of childbearing age, each of these medications would need to be stopped in order to achieve pregnancy and, in cases in which women take a GnRH agonist or synthetic male hormone, to achieve pregnancy safely.
Women today are finding that many more options exist to help them fight the debilitating symptoms of endometriosis. Additionally, as public awareness has been focused on this disease, research centers devoted to the study of endometriosis have been established at major universities, including Dartmouth College in Hanover, New Hampshire and Vanderbilt University in Nashville, Tennessee.