women s health issues
Endometriosis
Treatment of Endometriosis
Nonsteroidal anti-inflammatory drugs for pain Drugs to suppress the activity of the ovaries Surgery to remove or destroy the misplaced endometrial tissue Sometimes surgery to remove only the uterus or the uterus and the ovaries Endometriosis treatment depends on a woman's symptoms, pregnancy plans, and age, as well as the stage of endometriosis. ( Nonsteroidal Anti-Inflammatory Drugs ) are used to relieve pain. They may be all that is needed if symptoms are mild and women do not plan to become pregnant. Drugs can be used to suppress the activity of the ovaries and thus slow the growth of the misplaced endometrial tissue and reduce bleeding and pain. The following drugs are commonly used: Combination Oral Contraceptives ( Other drugs that suppress the activity of the ovaries are usually used only when women cannot take combination oral contraceptives or when treatment with combination oral contraceptives is ineffective. They include Progestins (such asmedroxyprogesteroneandnorethindrone) Gonadotropin-releasing hormone agonists (GnRH agonists—such asleuprolideandnafarelin) GnRH antagonists (such aselagolixorrelugolix) Danazol(a synthetic male hormone, or androgen) However, these drugs may not eliminate endometriosis, and even if they do, endometriosis often recurs after the drugs are stopped unless more radical treatment is used to completely and permanently stop the ovaries from functioning. Combination oral contraceptivesare used primarily in women who do not plan to become pregnant soon. Oral contraceptives may also be used after treatment withdanazolor a GnRH agonist to try to slow progression of the disorder and to reduce pain. The oral contraceptives can be taken continuously, especially if pain is worse during menstrual periods. GnRH agoniststurn off the brain's signal to the ovaries to produceestrogenandprogesterone. As a result, production of these hormones decreases. Side effects of GnRH agonists include hot flashes, stiff joints, mood changes, and vaginal dryness. Continued use of GnRH agonists for more than 4 to 6 months causes a decrease in bone density and may lead to osteoporosis. To minimize the decrease in bone density, doctors may give women small doses of a progestin or a bisphosphonate (such asalendronate,ibandronate, orrisedronate). If endometriosis recurs, women may need to be treated again. TheGnRH antagonistelagolix, like GnRH agonists, suppresses estrogen production by the ovaries and, if it is taken for a long time, causes a decrease in bone density. If it is taken for more than 6 months, doctors may give women small doses of a progestin to minimize the decrease in bone density. Relugolix(another GnRH antagonist) combined withestradiolandnorethindroneis being studied as a treatment for endometriosis. This combination minimizes hot flushes and bone loss, but if it is taken for more than 24 months, bone loss may continue and may be irreversible. Danazolinhibits release of an egg (ovulation). However, it has side effects including weight gain and the development of masculine characteristics (such as increased body hair, loss of hair from the head, reduced breast size, and lowering of the voice). These side effects limit its use. After treatment with drugs, fertility rates range from 40 to 60%. Drugs do not change fertility rates in women with minimal or mild endometriosis. For most women with moderate to severe endometriosis, the most effective treatment is removing or destroying misplaced endometrial tissue and endometriomas. Usually, these surgical procedures are done through a laparoscope inserted into the abdomen through a small incision made near the navel. Such treatment may be needed in the following situations: When drugs cannot relieve severe lower abdominal or pelvic pain When adhesions in the lower abdomen or pelvis cause significant symptoms When misplaced endometrial tissue blocks one or both fallopian tubes When endometriomas are present When endometriosis causes infertility and the woman wants to be able to become pregnant When endometriosis causes pain during intercourse Often, misplaced endometrial tissue can be removed or destroyed during laparoscopy when the diagnosis is made. Sometimes electrocautery (a device that uses an electrical current to produce heat) or a laser is used to destroy or remove endometrial tissue during laparoscopy. Sometimes abdominal surgery (involving an incision into the abdomen) is required to remove endometrial tissue. Endometriomas (ovarian cysts caused by endometriosis) are usually removed because they are less likely to recur if they are removed than if they are drained. During surgery, doctors remove as much misplaced endometrial tissue as possible without damaging the ovaries. Thus, the woman's ability to have children may be preserved. Depending on the stage of the endometriosis, 40 to 70% of women who have surgery may become pregnant. If doctors cannot remove all of the tissue, women may be treated with a GnRH agonist. But whether this drug increases their chances of becoming pregnant is unclear. Some women who have endometriosis can become pregnant by using assisted reproductive techniques, such as In vitro (test tube) fertilization (IVF) . Surgical removal of misplaced endometrial tissue is only a temporary measure. After the tissue is removed, endometriosis recurs in most women unless they take drugs to suppress the ovaries or the ovaries are removed. Removal of the uterus but not the ovaries (hysterectomy without salpingo-oophorectomy) is often appropriate in women who do not plan to become pregnant, particularly when drugs do not relieve abdominal or pelvic pain. Sometimes both ovaries must be removed, as well as the uterus. This procedure is called hysterectomy plus bilateral salpingo-oophorectomy. It has the same effects as menopause because it, like Menopause , results in decreased Hysterectomy plus bilateral salpingo-oophorectomy may be done, for example, in the following situations: When women, usually those who are near menopause or who do not want to become pregnant again, want definitive treatment (to completely eliminate the disorder) When endometriosis has recurred, often many times 