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Treatment

Physicians have treated endometriosis in many different ways over the years but there is still no cure. Based on the severity of your symptoms, the results of your physical exam and other tests, your doctor will recommend a course of treatment.

Women with no symptoms or mild symptoms may require no treatment whatsoever; women with severe symptoms may need a combination of treatments. Some cases of endometriosis can be controlled with lifestyle changes while others require medical intervention.

To explore the treatment options available, use the links below.

Lifestyle changes and pregnancy | Medications | Laparoscopy | Hysterectomy

Lifestyle Changes and Pregnancy

Many women with endometriosis find that simple lifestyle changes can be very helpful in managing their condition.

Diet
It is important to maintain a well-balanced diet, based on Canada's Food Guide. A healthy diet, rich in whole grains, legumes, fruits and vegetables, helps to strengthen a person's immune system and improve overall health and well-being.

Since endometriosis has been linked to toxic chemicals, such as dioxin and PCBs, you should consult your physician or dietitian, who may recommend minimizing or eliminating your intake of red meat. Environmental dioxins and PCBs are often stored in animal fat.

Some women with endometriosis also benefit from reducing their intake of dairy products, as dairy products increase the production of prostaglandins, which in turn, can increase pain. It's important, however, to ensure that you get enough calcium and protein from other sources.

Exercise
Some doctors also recommend that women with endometriosis exercise during times when they do not feel any pain. Aerobic exercise, such as running or cycling, as well as meditative exercises, like tai chi, yoga and qigong, can help to relieve period pain.

Pregnancy

Pregnancy is not recommended as a treatment for endometriosis, but pregnancy usually offers women some relief from their symptoms.  Because it gets harder for a woman to get pregnant the longer she lives with the illness, women with endometriosis might be advised not to postpone pregnancy if the time is right. Some women also claim that breastfeeding reduces their symptoms; however, there is no scientific evidence to prove a lasting effect beyond the pregnancy.

Medications

A wide range of medications are prescribed for treating endometriosis. More research needs to be done to determine just how effective most of them really are. There is also no clear evidence that any of the following medications can improve a woman's chance of getting pregnant.

It is important that your doctor tell you about all of the side effects of any endometriosis medication. For example, if a young woman is given medication that simulates menopause, it may cause her bones to be weak. So while she is being treated for endometriosis, there may be other long-term effects to consider.

Over-the-Counter Drugs

Tylenol, Advil, Nupren, Midol 200 and Medipren are usually the first line of treatment in controlling pain. They are inexpensive and non-addictive. These may be helpful for many women with endometriosis.

Birth Control

If pain medications like Advil and Tylenol don't work, the next option might be to prescribe birth control hormones, in the form of pills, the birth control injection called Depo-Provera, a skin patch or a vaginal ring. Birth control hormones are one of the most widely used treatments for endometriosis.

This treatment, which stops a woman from ovulating each month, as well as the growing and shedding of endometrial tissue that makes endometriosis painful, relieves the pain of many women.

Birth control hormones simulate the hormonal environment of pregnancy. Some believe that this can shrink endometrial tissue and prevent the disease from progressing. However, more research is needed to determine how effective birth control hormones are at shrinking endometrial tissue.

In some cases, doctors will prescribe birth control pills without the usual seven-day break each month. This method prevents a period completely. This may be a useful option for women who experience the worst symptoms during menstruation.

The birth control combinations used to treat endometriosis have been shown to cause side effects such as nausea, blood clots, high blood pressure, enlarged uterus, acne and hair loss. These side effects are uncommon, and are linked to the dose used. Women who use birth control pills should not smoke, as this increases the risk of complications and serious side effects.

Progestins

Progestins are hormones, which behave like the female hormone progesterone, and can be used to shrink endometrial tissue. Progestin treatment usually stops a woman from ovulating each month.

The side effects vary depending on the dose and how it is administered. Possible side effects include breakthrough bleeding, nausea, weight gain, breast tenderness, fluid retention and depression.

If birth control pills or other hormones are not effective, then the stronger medications, described below, can be considered.

Danazol

Danazol is a drug that lowers a woman’s estrogen levels and increases her testosterone levels. Ninety percent of women report that the medication relieves their symptoms, though it does not cure the disease. It stops a woman's menstrual period and the pain that accompanies it, and puts her body in a state similar to menopause. In some cases, danazol also helps decrease pain during sex and bowel movements. Symptoms usually return shortly after women stop taking the medication.

Possible side effects include increased cholesterol levels, voice changes, acne, low sex drive, hot flashes, oily skin and hair, weight gain, muscle cramps, smaller breasts, vaginal dryness, face and body hair, and depression. When used to treat endometriosis, danazol may also increase a woman’s risk for ovarian cancer. Because of these side effects, many of which are common and some quite serious, the drug is not widely prescribed. When it is used, it is usually used for only a limited period of time.

GnRH Analogs

GnRH is a hormone that regulates a woman's menstrual cycle. GnRH analogs cause a woman to stop having her period and produce a state that is similar, but not identical, to menopause. In some cases, the doctor may also prescribe estrogen to help deal with these symptoms. The drugs are usually effective for treating period pain and pain during sex. One study found that the illness returned in about 50 percent of women five years after they stopped taking GnRH drugs.

GnRH analogs are also used to treat other disorders in women, such as fibroids and polycystic ovary syndrome, as well as premenstrual syndrome (PMS). The family of GnRH drugs include Lupron, Zoladex, Synarel and Suprefact. The side effects of these drugs, which tend to be similar to those of menopause, include osteoporosis, hot flashes, mood swings, vaginal dryness, smaller breasts and headaches.

These treatments are given by injection (every three months, every month or every day). They are also available in the form of nasal spray. These drugs are very expensive.

Laparoscopy

The same tool used to diagnose endometriosis can be effective for treating it. The laparoscope is a thin, lighted tube that is surgically inserted into the body. There are different kinds of laparoscopes used to remove endometriosis. The most common and most effective is the laser laparoscope.

A laser is a light that is focused in one direction and wavelength. The result is very intense energy that can be aimed with accuracy. Lasers are ideal for this kind of surgery because they can completely remove the endometriosis and there is less blood loss and less tissue damage than with other surgeries.

Surgeons use the following laparoscopic procedures to treat endometriosis:

Excision
A surgeon may cut out all of the endometrial tissue. Surgical excision (removal of the tissue) is helpful for many, but not all, women with endometriosis. The success of this procedure depends on the extent of the endometriosis and how long the surgeon is able to spend on the surgery. For a case of extensive endometriosis, it may take hours to remove all the nodules, but some facilities do not support that level of intervention. If you are considering this procedure, it is important to find a surgeon who has experience treating endometriosis using excision, and who works in a facility where enough time can be devoted to this type of surgery.

Vaporization
Vaporization destroys endometrial tissue using a high-power laser.

Coagulation
Coagulation is a technique that uses an electrical current to destroy endometrial tissue. It is important that the surgeon be able to recognize endometrial lesions. The lesions come in many forms, types and colours. Doctors who are not familiar with how endometriosis looks may miss it. If it is missed, then the patient may be told she is normal and healthy simply because everything looks normal to the doctor. Unfortunately, many women are still not properly treated for this reason.

Hysterectomy

Hysterectomy is the surgical removal of the uterus. When a hysterectomy is done to treat endometriosis, the ovaries are often removed as well. If the ovaries are not removed with the uterus, the chances of endometriosis recurring are greatly increased. In rare situations, part of the bowel may also be removed.

A hysterectomy plus removal of the ovaries is the most aggressive form of treatment for endometriosis and should only be considered as a last resort. It's important that all other available treatment options be explored first. Today, many doctors avoid performing a hysterectomy and removing the ovaries. They believe that the organs should always be preserved if possible. Once a woman has a hysterectomy, she will never be able to get pregnant. Also, having a hysterectomy does not guarantee that the endometriosis will be gone for good. In 20 percent of patients, the endometriosis will remain.

For effective treatment, it is vital that all visible lesions be removed at the time of surgery. Traces of endometrial tissue can be left behind if the surgery is not performed by an expert. Endometriosis can continue or return at any time, but recurrence is less likely if it is removed by an expert surgeon.

Once a woman has a hysterectomy, she will never be able to get pregnant. Having a hysterectomy is a big decision for a woman to make. It's important that all other available treatment options be explored first.

 

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