Well, the answer to this question depends on several factors that will be discussed thoroughly in this article, but the most important is to know at which stage your endometriosis is, in order to choose an appropriate method of treatment.
Furthermore, you need to know what endometriosis is, how it affects fertility, and that there are 4 stages of endometriosis. You will find out what interests you in our previous articles:
Treatment Methods For Endometriosis
To be honest, there is NO cure for endometriosis currently, but there are two main options:
- Treatment methods directed to reduce the pain and
- Treatment methods for improving fertility.
Before determining which method is best for your to treat endometriosis, healthcare providers consider several factors, like:
- Your age;
- How severe your symptoms are;
- How severe the disease is;
- Whether you want children or not;
You also should take into account that not all treatment methods work for all women. Also, unfortunately, the symptoms of endometriosis may return after the treatment is stopped.
Treatment Methods for Reducing pain from Endometriosis
There are 3 options for treating pain from endometriosis:
- Hormone therapy;
- Pain medications;
- Surgical treatment;
As it is known, hormones cause endometriosis patches to go through a cycle similar to the menstrual cycle. Hence hormones also can be effective to treat endometriosis-associated pain. Hormones come in the form of pills, a short or injection, or a nasal spray.
It’s important to know that hormone treatments stop the ovaries from producing hormones, including estrogen, and usually prevent ovulation. This helps to slow the growth and local activity of both the endometrium and the endometrial lesions.
Gonadotropin-releasing Hormone (GnRH)
Healthcare providers may suggest one of the following hormone treatments reduce pain from endometriosis.
Gonadotropin-releasing hormone (GnRH) medicines stop the production of certain hormones to prevent ovulation, menstruation, and endometriosis growth. The body is in the ‘’menopausal” state while treatment. A GnRH medicine called elagolix also Orilissa stops hormone release to prevent endometriosis growth.
It is the first pill approved by the U.S. Food and Drug Administration (FDA) to treat the pain associated with endometriosis.
What should you know about this medicine?
- The low-dose pill should not be taken for more than 24 months and the high-dose pill should not be taken for more than 6 months because it may cause bone loss!
- The most common side effects of the drug include headache, nausea, sleeping difficulties, absence of periods, anxiety, depression, and joint pain.
- Some GnRH medicines come in a nasal spray taken daily, or as an injection given once a month,or as an injection given every 3 months.
It is strongly recommended that you take GnRH medicine for only about 6 months at a time.
Oral contraceptives, or birth control pills that make a woman’s period lighter, shorter and regular, are also prescribed to reduce pain from endometriosis. In general, the therapy contains two hormones: estrogen and progestin, a progesterone-like hormone. Women who have cardiovascular problems or are under a high risk of blood clots can use only progestin pills and they don’t take estrogen.
Typically, women take pills for 21 days and then take sugar pills for 7 days to mimic the natural menstrual cycle.
Some women need to take these pills continuously, without using the sugar pills that signal the body to go through menstruation. Taking these pills without sugar pills, reduces or eliminates the pain. These hormones can have some mild side effects, such as weight gain, bloating, and bleeding between periods, especially when a woman starts taking these pills for the first time.
Pain medications may work well if pain or other symptoms are mild. These medications range from over-the-counter pain relievers to strong prescription pain relievers.
The most common types of pain relievers are nonsteroidal anti-inflammatory drugs, also called NSAIDS.
Well, the evidence on the effectiveness of these medications for relieving endometriosis-associated pain is limited. The understanding of which drugs relieve pain associated with endometriosis could also shed light on how endometriosis causes pain.
Research shows that some surgical treatments can provide significant, although short-term, relief from endometriosis-related pain, so healthcare providers may recommend surgery to treat severe pain from endometriosis. During the operation, the surgeon can locate any areas of endometriosis and examine the size and degree of growth; he or she also may remove the endometriosis patches at that time.
It is important to understand what is planned during surgery because some procedures cannot be reversed, and others can affect a woman’s fertility. Therefore, women should discuss all available options with their healthcare providers before making final decisions about treatment.
Healthcare providers may suggest one of the following surgical treatments for pain from endometriosis.
The surgeon uses an instrument to inflate the abdomen slightly with a harmless gas and then inserts a small viewing instrument with a light, called a laparoscope, into the abdomen through a small cut to see the growths.
To remove the endometriosis, a surgeon makes at least two more small cuts in the abdomen and inserts lasers or other surgical instruments to remove the lesions, this process is called excising. A surgeon may destroy the lesions with intense heat and seal the blood vessels without stitches. This process is called cauterizing or vaporizing.
Some surgeons also will remove scar tissue at this time because it may contribute to endometriosis-associated pain. The goal is to treat the endometriosis without harming the healthy tissue around it. With surgery, most women have pain relief in a short period of time, but the pain often returns. Some evidence shows that surgical treatment for endometriosis-related pain is more effective in women who have moderate endometriosis rather than minimal endometriosis. This happens because women with minimal endometriosis may have changes in their pain perception that persist after removing the lesions.
In this major abdominal surgery procedure, the surgeon may remove the endometriosis patches. Sometimes the endometriosis lesions are too small to see in a laparotomy. During this procedure, the surgeon may also remove the uterus. Removing the uterus is called a hysterectomy.
If the ovaries have endometriosis on them or if the damage is severe, the surgeon may remove the ovaries and fallopian tubes along with the uterus. This process is called total hysterectomy and bilateral salpingo-oophorectomy.
Having a hysterectomy or salpingo-oophorectomy does not guarantee that the lesions will not return or that the pain will go away.
Surgery to Sever Pelvic Nerves.
If the pain is in the center of the abdomen, healthcare providers may recommend cutting nerves in the pelvis to lessen the pain. This can be done during either laparoscopy or laparotomy.
Two procedures are used to sever different nerves in the pelvis.
- Presacral neurectomy severs the nerves connected to the uterus.
- Laparoscopic uterine nerve ablation (LUNA) severs nerves in the ligaments that secure the uterus.
In some cases, hormone therapy is used before or after surgery to reduce pain and continue treatment.
Treatment Methods for Infertility Related to Endometriosis
If pregnancy does not occur after laparoscopic treatment, in vitro fertilization (IVF) may be the best option to improve fertility.
Taking any other hormonal therapy usually used for endometriosis-associated pain will suppress ovulation and delay pregnancy. Performing another laparoscopy is not the preferred approach to improving fertility unless pain symptoms prevent undergoing IVF. Multiple surgeries, especially those that remove cysts from the ovaries, may reduce ovarian function and hamper the success of IVF.
IVF makes it possible to combine sperm and eggs in a laboratory to make an embryo. The resulting embryos are placed into the woman’s uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis.
All information about the IVF process and the preparation for starting it, you can see in our previous article named, Hormonal Indications for starting IVF
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