Treatment of Endometriosis
Treatment of Endometriosis
Endometriosis affects over 70 million women and girls world-wide (Endo Resolved). It is common among women of reproductive age, approximately 15%. On average it takes 7 years from the time symptoms appear to diagnosis and finally treatment. Women suffering from endometriosis experience chronic pelvic pain and loss of time and productivity from work and school. Some women of child bearing age also experience infertility (Ryan). Currently there are no cures for endometriosis. Treatments attempt manage pain relief and slow the progression of endometriosis (Ryan). The main goal of the treatment is to relieve the symptoms of pelvic pain, infertility, and pelvic mass associated with endometriosis. This accomplished using medical/drug therapies, surgical intervention, and combined therapies. There are a number of factors taken into consideration when deciding on what treatment method is best and is individualized for each woman. Often, a woman’s desire to bear children is a key decision maker. Other factors are age, severity of symptoms, stage of the disease and its location, prior treatments, and cost (Schenken). Endometriosis is often diagnosed during a laparoscopy, a diagnostic surgical procedure in which a lighted optical tube is inserted into the navel through a small incision. Using a laparoscope, the doctor will be able to view the presence of endometrial lesions or implants on the outside of uterus, ovaries, fallopian tubes, endometrial tissue, bowel, and/or appendix (Rushall, Cleveland Clinic). A variety of medical or drug therapies are available. Therapy choice is generally dependent on severity of the endometriosis and symptoms, as well as cost. Initial medical therapies include analgesics, such as non-steroidal anti-inflammatory drugs, and oral contraceptive pills. If these are not effective, hormonal interventions may be prescribed. Non-steroidal anti-inflammatory drugs (NSAIDS) are commonly prescribed for those with minimal pain. It is an effective treatment for those suffering from menstrual cramps (primary dysmenorrheal). Advantages to taking NSAIDS are they readily available, cost-effective, and cause minimal side-effects (Schenken). Oral contraceptive pills (OCPs) are commonly used for women with minimal to mild symptoms, also offering relief of menstrual cramps (Schenken). Although OCPs contain estrogen, which often stimulates endometriosis, pain relief is often experienced (Ryan). OCPs work by “inducing decidualization, or shedding, subsequent atrophy, and has shown conflicting evidence it can slow the progression of the disease.” The advantages to OCPs it will allow for the possibility of pregnancy in the future and can be taken for an indefinite period of time (Schenken). The three most common hormonal interventions used when NSAIDs and OCPs to do not provide enough relief and/or there is recurrent mild endometriosis and pain are: gonadotropin-releasing hormone (GnRH) agonist analogs, danazol, and progestins. Hormonal interventions alter a woman’s estrogen/progesterone levels. Hormonal treatments target the ovarian estrogen production or antagonized estrogen action, affecting the growth of endometriosis (Schenken). Gonadotropin - releasing hormone (GnRH) agonists are used for the treatment of moderate to severe pain associated with endometriosis to induce a state of “pseudomenopause”. GnRh agonists have been the most studied treatment for endometriosis (Ryan). Trials have shown that GnRH agonists are effective pain relievers in addition to reducing the size of endometriosis implants. A disadvantage of GnRH agonists is bone loss (Schenken). Under its FDA approval, GnRH can be prescribed for 6 months if it is used without an “add-back” therapy. Add-back therapy is hormone replacement to protect bone density and “to ameliorate vasomotor symptoms.” It can be extended for additional 6 months if used in conjunction with an “add-back” therapy (Ryan)....
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