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Endometriosis Treatment - what are the options?

The treatment options available to women who have been diagnosed with endometriosis will largely depend on the type and severity of the symptoms and whether the patient is seeking treatment because of infertility or to relieve the pain and discomfort of her endometriosis symptoms.

Most doctors prefer to confirm the diagnosis of endometriosis before commencing any treatment, with the most effective method being by laparoscopy, which enables the surgeon to view any areas of endometrial tissue outside the uterus. If infertility is the problem, doctors prefer to fully investigate all other possible causes of the infertility before attempting to diagnose endometriosis.

For women who are experiencing mild symptoms, a course of oral contraceptives or progestin is often first prescribed and the effectiveness of the medication in relieving pain and discomfort is then assessed. A recent strategy is to treat with a 3 month trial of GnRH, a hormone that inhibits gonadotropin secretion. If these treatments prove to be ineffective, other options can then be considered.

Other medical treatment options are available for women who experience dysmenorrhea (painful and heavy periods) or dyspareunia (pain during or after sexual intercourse). Medications used to treat endometriosis are inexpensive and most effective for relieving the pain associated with endometriosis. Unfortunately, some come with unwanted side effects. These treatments appear to have no affect on infertility caused by endometriosis.

Danazol has been very effective in addressing and relieving endometriosis symptoms, but it has some negative side-effects which make it a less attractive choice; there are now better-tolerated medications available. This drug is taken for a 6 month period, although the time can be extended to 9 months if the treatment is tolerated and effective. Side effects include headache, sweats, flushes, acne and weight gain.

The GnRH agents that inhibit gonadotropin secretion include leuprolide and gosarelin; they relieve pain similarly to danazol but with fewer adverse side-effects. The main side effect is mild bone loss, but this is usually reversed when the medication is stopped. Leuprolide is administered monthly by intramuscular injection; gosarelin is given subcutaneously and a nasal spray of nasfarelin is available and is used twice a day.

Oral contraceptive pills prevent ovulation; they directly have a thinning effect on endometrial tissue. Because all endometrial tissue in the body is affected, this has the effect of relieving pain and reducing the volume of menstrual flow, thus giving relief to the patient. Because of the limited side-effects, this treatment is able to be continued in the long-term, at least until pregnancy is desired.

Progestins are similar to the oral contraceptives in the effect they have on the endometrial tissue in the body, but they are known to have more negative side effects. One advantage they have is that they are considerably cheaper than the GnRH agents and danazol, which is why they are often prescribed as a first treatment option.

There are also surgical treatment options for women with endometriosis. While surgery is invasive and more expensive, it may have improved long-term results than medication, is the only option for treating infertility caused by endometriosis and is able to give a definitive and accurate diagnosis. The main benefit of surgery to women with fertility problems related to endometriosis is that often the surgical removal of misplaced endometrial tissue will remove the cause of their infertility. In fact, a recent study has shown that even patients with mild endometriosis had a 13% increase in pregnancy probability.

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