Endometriosis Treatment Options Every Patient Should Know About

Specialists recommend considering these five strategies.

Endometriosis impacts approximately one in 10 women globally, leading to issues such as infertility, disruptive pain affecting daily life, and discomfort during urination, bowel movements, and sexual intercourse.

Individuals diagnosed with endometriosis, a condition where tissue resembling uterine lining grows outside the uterus, have various treatment avenues available. Given the predominantly short-term nature of many treatments, individuals might explore multiple options over their lifetimes.

Regardless of the initial treatment choice for endometriosis, it is advisable to establish a multidisciplinary support team to effectively address the condition. Dr. Sanjay Agarwal, Director of the Center for Endometriosis Research and Treatment at the University of California, San Diego, emphasizes the value of a collaborative approach. His team comprises professionals such as nutritionists, pain management specialists, psychologists, and acupuncturists to comprehensively address the multifaceted nature of endometriosis.

Recognizing the complexity of endometriosis, Dr. Agarwal stresses that a single practitioner may not possess all the necessary skills for comprehensive care.

For individuals with mild cases, natural interventions like adopting an anti-inflammatory diet might effectively manage pain. This approach involves identifying and avoiding foods exacerbating symptoms. Additionally, alternative or complementary treatments such as acupuncture, mindfulness, and psychological therapy could yield positive results.

In contrast, those experiencing moderate to severe pain must weigh a broader range of treatment options. The severity of pain and its impact on daily life dictate the appropriate approach, potentially involving medication and surgical procedures.

Dr. Agarwal categorizes endometriosis treatments in terms of invasiveness, ranking them from least to most invasive.

Birth Control

In certain instances, endometriosis presents with mild symptoms that could potentially be alleviated through a straightforward approach such as a birth control pill. Often, a physician’s initial recommendation to a patient might involve prescribing this pill, as advised by Dr. Agarwal.

Given that endometriosis is influenced by estrogen levels, the birth control pill serves to regulate the condition by maintaining hormonal stability.

While comprehensive studies demonstrating the effectiveness of the pill in relieving endometriosis symptoms are lacking, it’s noteworthy that the medication is economical, relatively safe with minimal side effects, and could offer relief to a subset of women, according to Dr. Agarwal.

This could explain the endorsement of birth control pills as a primary treatment by organizations like the American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM), particularly for managing endometriosis-related pain that remains uncontrolled by over-the-counter pain relievers like Motrin or Advil.

Alternatives in the realm of contraception encompass the birth control shot, which functions by suppressing ovulation and thinning the endometrial lining to mitigate pain. Nevertheless, in comparison to the birth control pill, some individuals might encounter more challenges with mood fluctuations, weight gain, and sporadic spotting when using the shot, as highlighted by Dr. Agarwal.

Dr. Agarwal further emphasizes that while comprehensive studies on birth control pills might be limited, they exhibit efficacy for a significant portion of women. He advocates that if these pills don’t yield the desired results, a shift toward more potent medications and consideration of surgical options could be warranted.

Gonadotropin-Releasing Hormone Antagonists and Agonists

When conventional birth control pills prove ineffective, individuals have the option to delve into more potent and potentially invasive treatments for alleviating their endometriosis-related pain.

Orilissa, the first FDA-approved endometriosis medication in over a decade, offers a solution in the form of two distinct dosage levels tailored to address moderate to severe pain. Classified as a gonadotropin-releasing hormone (GnRH) antagonist, Orilissa functions by binding to hormone receptors, curbing the production of estrogen and progesterone in the body, ultimately leading to pain reduction.

Common side effects associated with the drug encompass phenomena like hot flashes, headaches, and insomnia. However, it’s important to note that Orilissa can also lead to more serious side effects in a minority of cases, including a decline in bone density and a heightened risk of experiencing suicidal thoughts and behaviors, particularly among women with a history of depression. Dr. Agarwal expresses optimism about its approval due to the availability of two dosage options and the convenience of its oral administration, allowing individuals to discontinue usage with ease if desired.

Further FDA-approved options in this realm involve GnRH agonists, which signal the pituitary gland to halt the secretion of hormones that stimulate estrogen production in the ovaries. A notable example within this category is Lupron, administered through injection. These injections suppress estrogen to prevent the formation of endometrial lesions, although they may result in similar side effects as seen with Orilissa.

To counteract these potential side effects, individuals may also receive guidance to incorporate a small amount of the blocked hormones through daily progesterone or estrogen pills, a strategy referred to as “add back.”

Ultimately, the progression from birth control pills to more advanced treatments highlights the commitment to finding effective solutions tailored to each individual’s specific circumstances and needs.

Androgen Medication

Danazol, known by its generic name, holds the distinction of being the inaugural medication approved by the FDA for the treatment of endometriosis. Its introduction in the 1970s led to widespread usage, yet its popularity has since waned across much of the Western world.

The mechanism of action of this medication involves elevating the levels of male hormones, or androgens, within the body, with the intention of reducing estrogen levels. However, the side effects associated with danazol frequently include the development of increased body hair, deepening of the voice, breast size reduction, and acne.

Presently, danazol’s utilization is considerably diminished, as modern medical practice has evolved. Dr. Agarwal aptly characterizes this drug as “quite invasive,” highlighting the inclination towards alternative and more refined treatment approaches in the contemporary medical landscape.

Opioids for Chronic Pain

Certain women grappling with endometriosis find themselves prescribed opioids—potent pain-relieving medications with the potential for addiction—either to manage chronic pain or to alleviate discomfort following surgical interventions for the condition.

However, medical practitioners are increasingly exercising caution when it comes to long-term opioid prescriptions, irrespective of the underlying condition. A telling statistic from 2017 reveals that approximately 1.7 million Americans struggled with substance use disorders stemming from prescription opioids, with opioid-related overdoses claiming the lives of 47,000 individuals, as reported by the National Institute of Drug Abuse.

Experts underscore that the most effective strategy for curbing dependency on opioids is to prevent their initiation altogether. This realization has prompted medical professionals to adopt a proactive approach by scaling back their issuance of opioid prescriptions, aligning with the overarching goal of minimizing the risks associated with these powerful medications.

Surgical Treatment

In some cases, medications may not effectively alleviate the pain or cramping associated with endometriosis, even after trying various options. Additionally, pharmaceutical interventions cannot reverse the damage that untreated, prolonged endometriosis might have caused, such as adhesions or scarring.

Furthermore, it’s crucial to note that while medications are less invasive than surgical procedures, they might not be suitable for women who are attempting to conceive. According to Hugh Taylor, MD, Vice President of the American Society for Reproductive Medicine (ASRM) and Chair of Obstetrics, Gynecology, and Reproductive Science at Yale School of Medicine, surgical intervention might be recommended for individuals who don’t respond to a trial of at least two medications. Dr. Taylor, who combines medical therapy and surgery in treating endometriosis, emphasizes persistence and suggests that opting for surgery is appropriate when immediate pregnancy is desired or medication usage isn’t feasible.

Generally, surgical treatment of endometriosis involves a laparoscopy procedure. This entails a small abdominal incision for the insertion of a laparoscope, a slender illuminated instrument. Subsequent tools are introduced to remove endometrial implants that may be on the abdominal walls or other organs’ surfaces. Additionally, surgeons may excise endometriomas (endometrial cysts on the ovaries) and address adhesions (scar tissue) that might have developed due to the condition. In select cases, women may decide to undergo removal of organs like the ovaries or uterus.

Dr. Taylor underscores the importance of selecting a surgeon with expertise in endometriosis and who operates within a multidisciplinary team, often collaborating with specialists from various domains, such as gastrointestinal surgeons, as needed.

Post-surgery, women might experience pain relief and reduced bleeding; however, it’s important to maintain long-term medical treatment to prevent endometriosis from recurring, Dr. Taylor advises.

Diagnosing Endometriosis

Although influential figures in Hollywood and the media are playing a pivotal role in increasing awareness about endometriosis, there persists a significant number of women who endure years of pain prior to receiving a formal diagnosis, according to Dr. Agarwal.

Research indicates that there can be a substantial time span, ranging from three to 11 years, between the onset of pain and an eventual endometriosis diagnosis. Historically, part of the delay stemmed from doctors hesitating to confirm a diagnosis without surgical validation. While this dynamic is gradually evolving, experts contend that greater consciousness regarding endometriosis and its symptoms is imperative both within the medical community and the general public.

Dr. Taylor underscores that intensifying menstrual cramps often serve as an initial indicator. He points out, “If the cramps are debilitating to the extent of impeding work or school attendance, it is highly likely to be endometriosis.”

Dr. Agarwal concurs, highlighting that surgical intervention is not always a prerequisite for diagnosis. His emphasis is on swiftly advancing to the treatment phase without unnecessary delays.