Endometriosis

Treatment:

Treatment depends on the extent of the disease (decided through laparoscopy); the woman's desire for future childbearing; the degree of symptoms experienced; and the woman's age.

Observation may be the appropriate treatment for younger women with minimal disease and symptoms. It is important to have the woman maintain a regular schedule of woman's health care examinations (every 6 to 12 months) to note any changes or progression of the disease.

Treatment with medications may focus on several strategies:
Analgesic therapy, treating the discomfort of the disease only, may be indicated for women with mild to moderate premenstrual pain, with no pelvic examination abnormalities, and with no immediate desire to become pregnant.

"Pseudopregnancy" (a state resembling pregnancy) may be achieved through hormonal drug regimens. This approach was developed in response to the observed regression of endometriosis during pregnancy. Pseudopregnagncy can be induced using oral contraceptives containing estrogen and progesterone. This procedure takes six to nine months and relieves most of the symptoms, but does not prevent scarring and adhesion left by the disease. Potential side effects of depression and/or significant breakthrough spotting may limit this option for treatment.

Similarly, "pseudomenopause" (a state resembling menopause) was developed as a means of treatment because of the observation that endometriosis regresses after menopause. Danazol, a weak androgenic (male characteristic) hormonal drug may be used to reduce natural levels of estrogen and progesterone to low levels. It appears that the use of Danazol may be superior to the "pseudopregnancy" regimens in controlling symptoms and progression of the disease in women with moderate-to-severe endometreosis. However, in cases of mild disease, Danazol may prove to be much more expensive and no more effective than simple observation.

A new class of antigonadotropin drugs has been developed that also produces a "pseudo menopausal" state in women. Both Synarel and Depolupron (trade names) prevent stimulation of the pituitary for the production of FSH (follicle stimulating hormone) and LH (luteinizing hormone). This stops the ovary from producing estrogen. Potential side effects of these drugs include menopausal symptoms such as hot flashes, vaginal dryness, mood changes, and early loss of calcium from the bones.

Surgery is usually reserved for women with severe endometriosis, including adhesions and infertility. Conservative surgery attempts to remove or destroy all of the outside endometriotic tissue, remove adhesions, and restore the pelvic anatomy to as close to normal as possible. Nerve removal (neurectomy) may be performed during surgery as a means of relieving the pain associated with endometriosis.

Definitive surgery is appropriate for the woman with severe symptoms or disease, and no desire for future childbearing. This type of surgery involves abdominal removal of the uterus, both ovaries, both Fallopian tubes, and any remaining adhesions or endometrial implants. Hormonal replacement therapy may be indicated after total hysterectomy and should be tailored to the individual woman's needs.

Expectations (prognosis):

Enhanced fertility (frequently a goal of conservative surgery) is indirectly proportional to the extent of the endometriosis. Pregnancy rates, achieved after conservative surgery in women previously considered to be infertile, are approximately 75% for mild endometriosis, 50 to 60% for moderate cases, and 30 to 40% for severe cases. These are approximate values based upon statistics because endometriosis is a very individualized disease process.

Complications:

Infertility may result from endometriosis. Therefore, if a woman desires to have children and knows she has the disease, it may be recommended that she plan to have her children earlier and with shorter time spans in between children. Endometriosis has been known to recur even after a hysterectomy. Other complications are rare. In a few cases endometriosis implants may cause obstructions of the gastrointestinal or urinary tracts.

Calling your health care provider:

Call for an appointment with your health care provider if symptoms of endometriosis occur, or if back pain or other symptoms recur after treatment of endometriosis.

Screening for endometriosis should be considered if your mother or sister has been diagnosed with endometriosis, if you are unable to become pregnant after 1 year of attempting to conceive.