Endometriosis is a poorly understood and enigmatic disease. Its causes are not known.
Therefore, the medication targets the symptoms of endometriosis, by relieving the woman from the pain associated with the disease, thus improving her quality of life.
The treatment is purely symptomatic.
It is very important to choose the right treatment for you. You can help your doctor by recording and discussing all your symptoms with him.
Planning to get pregnant will influence the treatment of choice.
The medical treatment is effective against the pain and has no indication in the treatment of infertility related to endometriosis.
The painkillers, (such as non steroid anti-inflammatory drugs, NSAIDs), alter the way that the body perceives the pain. These drugs are not specific to endometriosis and they do not change the mechanism of the disease, as hormonal treatments do. They are cheap, easily found, widely used, with few side effects. Despite that, there is a scarcity of medical research, on how effective they are, in reducing the pain of endometriosis.
When NSAIDs are used for long periods of time, it is important to protect the stomach with medication, to stop possible side effects.
Endometriosis is an estrogen dependent disease. All hormonal treatments aim to reduce the levels of circulating estrogens in the blood. Suppressing the menstrual cycle, stops the menstrual bleeding and shrinks the endometriosis spots.
Hormonal treatments have side effects, variable effectiveness, significant cost, and above all their pain relief is only temporary.
The oral contraceptive pill
The use of the oral contraceptive pill is widely accepted, by women, for contraception. It contains small quantities of estrogen and progesterone. It suppresses follicular development and ovulation and therefore, the levels of circulating estrogens are low.
The low levels of estrogens can not support the endometrium either inside or outside the uterus (endometriotic lesion). Furthermore, progesterone acts directly on the endometrium and reduces its activity.
Hormonal contraceptives can be used either orally, as tablets or vaginally as a vaginal ring. The vaginal ring is placed in the vagina for 21 days. It can easily be inserted and removed by the user.
Progesterone and progestagens
Progestagens have various routes of administration. They can be taken orally as tablets, via intramuscular injection that lasts three months or as an intrauterine device that slowly releases levonorgestrel.
Medroxyprogesterone acetate, cyproterone acetate, dinogest and danatrole belong to this class of agents. These drugs can also be used as contraceptives.
Antiprogestagens such as gestrinione have a similar mode of action.
Their main advantage is their low cost. Each one, has its own side effects.
After consulting with your doctor, he will suggest the best drug for you. If you do experience any side effects, you should report them to your doctor.
The GnRH analogues profoundly suppress ovarian function, thus creating a hypo-estrogenic state. They are administered by intramuscular injection that can last 1or 3 months. The most commonly used are nafarelin, triptorelin, buserelin, goserelin and leuprolide. They are more expensive than the contraceptive pill or the progestagens and they do have more side effects.
Their side effects are related to the very low level of estrogens they cause and are similar to an artificial menopause. Hot flashes, night sweating, vaginal dryness and dyspareunia are common complains. Sometimes they may even cause depression. Their long term use can result in osteoporosis.
In order to eliminate these side effects of the GnRh analogues, we add on a hormonal treatment, such as the pill. The pill will deal with the side effects, while in the background the GnRh silently suppresses the endometriosis.
GnRh analogues should not be used in women with endometriosis before the age of 23, because these woman have not yet attained their peak bone density.
Aromatase is an enzyme necessary for the production of estrogens. The use of aromatase inhibitors is new in the treatment of endometriosis and there is not enough clinical experience. The significant reduction of estrogen levels causes side effects similar to those of GnRh analogues.
Their use is indicated when all other treatment have failed.
Intrauterine device Mirena
The Mirena intrauterine device is different from common coils, because it does not contain copper. Its contraceptive function is due to the daily release of levonogestrel into the endometrium, for five years.
It is very user friendly with minimal side effects. It is effective in reducing the pain of endometriosis and is particularly useful in women with deep infiltrating endometriosis.
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