While there is no specific cure for endometriosis, there are nonetheless, various treatments which are designed to deal with the associated pain. An endometriosis specialist will look at several factors when weighing up the best possible treatment/s for your personal case. These include: the severity of the disease; the intensity of your symptoms; your age; and whether you want to have children [1].
“Although medical treatment can provide temporary relief, most patients can achieve long-term sustained pain relief when it is combined with surgical intervention” [2]
Optimal Pain Management
At the present time, professional discussion as to how to optimally control endometriosis-linked pain, is still ongoing. This is due to the intricacy of the condition’s pathophysiology (disordered physiological processes associated with injury or disease), which comprises both hormonal and inflammatory changes and alterations to the brain’s signalling pathways.
Optimal management for endometriosis can necessitate, “1: possible egg preservation in affected young patients with and without endometriomas; 2: preoperative medical suppression to inhibit ovulation and to avoid removal of functional cysts that might look like endometriomas; and 3: postoperative hormonal suppression to decrease recurrence” [2]. However, before any treatment plan is drawn up, the specialist will have an in depth discussion with your regarding your fertility goals. He/she will also explain why you are getting the symptoms you are experiencing, and your level of severity of the disease. The treatment you will receive will be modified to your personal circumstances and condition [2].
The Different Treatments for Endometriosis Pain
These comprise:
• Pain medication
• Hormone therapy
• Surgical treatment
Pain Medication
If your pain or other symptoms from endometriosis, are moderate, then particular pharmaceuticals which are designed to ameliorate pain, could be very beneficial. NSAIDS (nonsteroidal anti-inflammatory drugs) are the most common form of pain relievers. Of note: “evidence on the effectiveness of these medications for relieving endometriosis-associated pain, is limited” [1], and more research is needed [1].
Hormone Therapy
“Hormone therapy is used to treat endometriosis-associated pain. Hormones come in the form of a pill, a shot or injection, or a nasal spray” [1]
Not only are various hormones capable of changing patients’ perception of pain; they can also
be instrumental in ameliorating endometriosis symptoms. The latter is due to the fact that just like the menstrual cycle, hormones induce patches of endometriosis to go through a cycle [1].
So How do the Hormone Treatments Actually Work?
These prevent the ovaries from generating oestrogen and other hormones, and normally stop ovulation from occurring. This can assist in slowing down the local activity and growth
of both endometrial lesions and the endometrium. Moreover, such treatment is also instrumental in preventing the growth of new areas and adhesions (scars). Of note: this treatment cannot however, eradicate any existing scars [1].
What Hormone Treatments Can Help Endometriosis Pain?
Your endometriosis specialist may propose one of the following hormone treatments for ameliorating your endometriosis pain:
• GnRH (gonadotropin-releasing hormone) medicine prevents the output of particular hormones which halt menstruation, ovulation, and endometriosis growth. This form of treatment transforms a woman’s body into a state of menopause [1].
• Birth control pills (oral contraception): can help to generate more regular, shorter and lighter periods. “Women prescribed contraceptives also report relief from pain” [1]. To that end, a large percentage of women carry on with this treatment indefinitely. Of note: the pain relief generally only goes on for the the time you are on the birth control pills. – Once you stop, the endometriosis symptoms can come back. Furthermore, you will also regain the ability to become pregnant. Interestingly, in rare cases, some women do not experience any endometriosis pain for a few years after coming off this form of birth control [1].
• Progesterone and progestin (synthetic progesterone): improve endometriosis symptoms by either completely stopping, or reducing a woman’s period. This also prevents the woman being able to get pregnant. The hormones/synthetic hormones are administered via an injection; by taking a pill, or through an IUD (intrauterine device). “As a pill taken daily, these hormones reduce menstrual flow without causing the uterine lining to grow. As soon as a woman stops taking the progestin pill, symptoms may return, and pregnancy is possible” [1]. Moreover: an IUD containing progestin, may be effective in reducing endometriosis-associated pain. It reduces the size of lesions and reduces menstrual flow” [1]. Of note: after taking the medication for 12 months, 33% of women still do not have a period [1].
• The drug Danazol (Danocrine®): prevents the hormones concerned with the menstrual cycle, from being released. While on this medication, women either do not have a period at all, or only experience one occasionally [1].
Surgical Treatment
“Currently available knowledge & advanced surgical techniques can be used to reduce the torment & suffering of those afflicted with endometriosis” [2]
Scientific studies on a number of surgical treatments, indicate that they can: “provide significant, although short-term, relief from endometriosis-related pain” [1]. At the time of your operation, your endometriosis surgeon will be able to pinpoint any areas with endometriosis, and examine its level and size of growth. Moreover, any endometriosis patches can also be removed during the operation. [1].
“Surgery remains the mainstay in definitive diagnosis. High-definition video laparoscopy with or without robotic assistance, is the standard initial approach” [2]
Indeed, 981 women who were suffering from varying levels of endometriosis, took part in a prospective, multi-centre cohort study. The results showed: “significant post-surgical symptom improvement over 36 months in patients who underwent laparoscopic excision of endometriosis. The most notable improvement was seen in dysmenorrhea, with a 57% reduction in symptoms; chronic pelvic pain and dyspareunia were reduced by 30%” [2].
The Use of Hormone Therapy Prior To & Post-Surgery
In certain cases, in order to continue treatment or lessen pain, hormone therapy may be given to a patient prior to, or post-surgery. Of note: “current evidence supports the use of an IUD containing progestin after surgery to reduce pain” [2].
References
[1]. National Institutes for Health (2020). “What are the treatments for endometriosis?”
https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/treatment
[2]. Nezhat, C. “Optimal Management of Endometriosis and Pain.” Obstetrics & Gynecology: October 2019 – Volume 134 – Issue 4 – p 834-839.
https://journals.lww.com/greenjournal/fulltext/2019/10000/optimal_management_of_endometriosis_and_pain.25.aspx
