Endometriosis

There is no universally valid optimal treatment.
Although endometriosis does not heal, the recommended treatment can remove the pain and resolve infertility. Treatment depends on the severity of symptoms and the desire to become pregnant.

Therapeutic recommendation is surgery for the removal of ectopic tissue or Danazol therapy, an anti-estrogenic, but the drug produces unpleasant side effects. Besides, the disease tends to return after some time and if it worsens, the only solution would be a hysterectomy (removal of uterus). I believe that treatment should be aimed at potential factors that led to the disease, trying to eliminate accumulated toxins, balance the hormonal balance, to strengthen the central nervous system.

Treatments attempt to obtain pain relief or to treat the sterility, given that there is currently no treatment for this condition.

Analgesics

To relieve pain, your doctor may recommend painkillers such as ibuprofen (Advil, etc.).. However, if pain is still present even after taking the maximum dose, you have to adopt a different treatment to reduce signs and symptoms.

Hormone therapy

Hormone therapy is effective in reducing or eliminating pain caused by endometriosis, because hormonal fluctuations during the menstrual cycle cause thickening and disintegration of endometrial implants bleeding.
Oral contraceptives – help to control the hormones responsible for monthly accumulation of endometrial tissue. For most women, menstruation becomes shorter and less abundant when taking these contraceptives. In addition, the treatment reduces and even eliminates the pain that accompanies endometriosis.

Agonists and antagonists of Gn-RH (gonadotrophin releasing hormone) – these drugs block the release of hormones that stimulate the ovaries. So, they stop menstruation and reduce estrogen levels, causing endometrial implants decrease. GnRH agonists and antagonists of a train artificial menopause can have adverse effects such as hot flashes or vaginal dryness. A small dose of estrogen can be taken together with these medicines to reduce side effects.

Danazol (Danocrine).
Another drug that blocks production of hormones that stimulate the ovaries and stop menstruation and symptoms of endometriosis is danazol. In addition, the drug interrupts endometrial proliferation. However, danazol is not the first choice of treatment because it can lead to adverse effects such as acne and excessive facial hair.

Medroxyprogesterone.
Administered by injection, this medicine stops menstruation and proliferation of endometrial implants, thereby reducing the signs and symptoms of endometriosis. Its side effects include weight gain and depression.
Inhibitors of aromatase – these inhibitors, used to treat breast cancer, may be effective in treating endometriosis. Inhibitors of aromatase block the conversion of androstendione and testosterone to estrogen as well as the production of estrogen by the endometrial implants. Thus, the body is deprived of the estrogen required for the proliferation of the endometrium.

Major recommendations in endometriosis
 In most patients with chronic pelvic pain the treatment with GnRH agonists for at least 3 months or Danazol for at least 6 months have similar efficiency.
 If treatment with GnRH agonist it is recommended a combination of alternative therapies to reduce or eliminate bone loss induced by agonists of GnRH.
 GnRH agonist therapy can be started in women with chronic pelvic pain even in the absence of surgical confirmation of endometriosis, but after rigorous exclusion of other causes of pelvic pain.
 For the treatment of the pelvic pain in endometriosis oral contraceptives are just as effective (contraceptive pill) or depot medroxyprogesterone acetate form, available treatments in terms of cost.
 Estrogen replacement therapy is contraindicated after a hysterectomy with bilateral anexectomie for endometriosis.
 In severe endometriosis, medical treatment is often insufficient.
 Since endometriosis is unpredictable and may regress spontaneously, in asymptomatic patients is recommended for expectant conduct.
 In comparison to laparotomy, operative laparoscopy in the surgical treatment of endometriosis-related pelvic pain is associated with faster recovery, less risk of postoperative adhesions and lower rate of complications.
 Danazol treatment cost is lower than that of treatment with GnRH analogues and more expensive than treatment with contraceptive pills or medroxyprogesterone acetate.
 Danazol at a dose of 600-800 mg daily is as effective as GnRH agonists, but is associated with a significantly increased incidence of side effects.
 GnRH agonists are associated with decreased bone density (bone demineralization) and vasomotor symptoms (heat waves, migraine, depression, vaginal dryness, dyspareunia).

Should hormone therapy be used to treat endometriosis?
If hormone therapy is not effective or if the endometrial proliferation affects other organs, the next necessary step is surgery to remove endometrial proliferation and mucosal scars. It consists of one or more small incisions, called laparoscopy. After surgery, hormone therapy may prevent the recurrence of endometriosis. Surgery removes the pain for a year or 2 years, although in 20% of women it persists.
In severe cases of endometriosis the treatment option consists in removing the uterus and ovaries (hysterectomy and bilateral oophorectomy). Early menopause is established following this therapy. This radical therapy is reserved for women who had children and in which other treatments had low effect. However, more than 15% of women continue to complain of pain after radical therapy.

Reappearance of pain after hormone therapy
After any hormone treatment, the pain of endometriosis can recur:
- In a year, more than 20% of women treated with hormonal drugs are again sore
- At 37% of women who had hormone treatment for mild forms of endometriosis, pain occurring later than 5 years post-treatment
- At 74% of women who had hormone treatment for severe forms of endometriosis, pain occurring later than 5 years post-treatment.
Using GnRH or progesterone for treatment of recurrence of pain is recommended when the pain is as strong as or worse than at the beginning.