Endometrial tissue lines the inside of the uterus and is usually shed and regenerated every month during the menstrual cycle. In a person who has endometriosis, however, this tissue grows in other areas of the body, most commonly in the abdomen or pelvis. When endometrial tissue grows outside the uterus, it does not shed during menstruation. Instead, it builds up, eventually leading to scarring, inflammation, and cysts that cause pain and other symptoms.
Multiple treatments are available for endometriosis, with varying degrees of effectiveness.
NSAIDs are a common first-line treatment for managing endometriosis pain. A study done on rats showed that some NSAIDs might inhibit the growth of endometrial tissue, and they are commonly effective in treating general menstrual pain.
Interestingly, little research has shown that this drug class effectively treats pain due to endometriosis specifically, though it is still commonly prescribed.
Birth control pills have been proven effective in treating pain from endometriosis but may not work for people who have severe pain during their periods.
Birth control pills are a first-line treatment for endometriosis, with combinations of estrogen and progesterone or progesterone alone believed to slow the progression of the disease to varying degrees. Low-dose pills are usually recommended as higher doses can increase the risk of blood clots.
GnRH, or gonadotropin-releasing hormone, stimulates female-at-birth bodies to produce estrogen and progesterone, directly affecting ovulation and menstruation. GnRH agonists can relieve endometriosis symptoms by blocking estrogen production in the ovaries.
This treatment approach is similar to the birth control pill but with much stronger effects. People taking GnRH agonists experience symptoms similar to menopause and may have reduced bone density over time.
The aromatase enzyme helps convert precursors of estrogen into estrogen. While most of the estrogen is produced in the ovaries, other parts of the body—including fat tissue, the breasts, the liver, and the adrenal glands—produce small amounts. Unlike other treatments for endometriosis that affect estrogen, aromatase inhibitors block estrogen synthesis in the ovaries and other parts of the body, making them an effective treatment for postmenopausal women whose estrogen is produced outside of their ovaries.
Some aromatase inhibitors may be combined with birth control pills, GnRH agonists, or progesterone, which can significantly decrease pain and the size of the abnormal tissue growth.
Progesterone and progestin (a synthetic form of progesterone) are effective treatment options for anyone who cannot take estrogen. Multiple forms of progesterone and progestin therapy are available and effectively relieve endometriosis symptoms like pain. Some may even lessen the size of abnormal growths.
One progestin, levonorgestrel-releasing intrauterine system or LNG-IUS, is a coil inserted into the uterus that is only used as a supplement to surgery and has been shown to relieve symptoms better than surgery alone.
Laparoscopy is a surgical procedure to treat endometriosis. In a laparoscopy, a surgeon makes several small incisions in the patient's abdomen. They insert a thin, flexible tube with a camera and small surgical instruments to remove endometrial growths and cysts using an electrical current or laser.
The patient usually goes home the same day as the procedure unless there are complications. This treatment works well to relieve the pain of mild to moderate endometriosis and may improve infertility.
A laparotomy is similar to laparoscopy in that it removes endometrial growths with a laser or electrical current, but instead of small incisions, a laparotomy involves cutting through the abdominal wall. A surgeon may choose to perform a laparotomy if the patient's condition is more extensive, such as with deeply infiltrative endometriosis, a rare form that causes the tissue to spread to the bladder or intestines.
As this procedure is more invasive, recovery time is longer, and it usually requires a hospital stay.
Endometrial growths in the uterus can cause significant pain and other symptoms. When other treatments are ineffective and symptoms interfere with daily life, a hysterectomy or removal of the uterus may be an option. This procedure causes infertility, so the surgeon and patient must consider age and whether or not the patient intends to have children in the future.
There is a risk of symptoms returning after a hysterectomy. Pain persists in about 15 percent of patients, and as much as five percent have increased pain or new symptoms after the procedure. The patient may have the ovaries and fallopian tubes removed as well in an attempt to avoid these risks, but this is a big consideration because it stops the production of female sex hormones, causing sudden menopause.
Because endometriosis pain is so difficult to treat, many people try alternative and natural treatments, like acupuncture or chiropractic treatment, but there is no reliable evidence that these techniques are effective.
Limited evidence suggests dietary supplements, especially B vitamins, may help, but no randomized controlled trials have studied this. Herbal supplements may also have unintended side effects or interact with other medications. One home remedy that may be temporarily effective is applying heat to relieve cramps, either by using a hot water bottle or taking a hot bath.
People may also try yoga, meditation, or general relaxation techniques to deal with endometriosis pain, but there is no reliable evidence that these are effective. There is, however, evidence that relieving relaxation practices can work as a supplementary treatment to reduce chronic pain.
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