I have endometriosis. . .How do I treat it medically? (part 1 of 3)

Once you are officially diagnosed with endometriosis (this requires surgery, see previous post) then you and your provider should have an in depth conversation about how to manage this condition.

Treatment of endometriosis is unique to the severity of a woman’s symptoms, their desire for future pregnancy, age and ability to tolerate medication side effects. You should take your time deciding how you would like to proceed and make sure to have your questions answered.

The American Society for Reproductive Medicine states that “endometriosis should be viewed as a chronic disease that requires a lifelong management plan with the goal of maximizing the use of medical treatment and avoiding repeated surgical procedures”. 

The options for treatment often fall into three categories (or a combination of these three categories) listed below:

  1. Medical management (pain medicines or hormonal medications)
  2. Surgical management (we will talk about this in an upcoming post)
  3. Alternative treatments (we will also talk about this in an upcoming post)

Before we start let’s review again how we make the diagnosis of endometriosis. A surgery is required before the diagnosis of endometriosis is made. You need to have a surgeon see the endometriosis and/or biopsy the area in question during surgery. Though there are exciting new options emerging (like specialized ultrasounds or biopsies) the standard at this time still requires surgery to make an accurate diagnosis.

However, remember that if you and your doctor think that you have endometriosis you can start medical treatment for your symptoms prior to surgery.  That means, you can use the same medications to improve your symptoms prior to having surgery.

The idea is that if you can feel better using the medications we normally use for endometriosis then we can proceed assuming you have endometriosis and you can avoid surgery.

Let’s assume that you have been diagnosed with endometriosis or at least you and your doctor have agreed to proceed with medical management prior to surgery. In general, the idea is to prevent hormones from triggering endometriosis pain. Estrogen is a hormone made by our ovaries during our reproductive years (first period to menopause). Estrogen is the culprit when it comes to endometriosis and can cause worsening symptoms related to endometriosis.

What are the options?

  1. Pain management with non-steroidal anti-inflammatories (NSAIDs): this is the formal terminology for mediations like Motrin, Ibuprofen, Advil, Aleve, Naproxen
    1. These are great options for women with mild to moderate pain. That is the symptoms of pain do not interfere with work or school. There is no superior brand of NSAID when discussing pain relief from endometriosis.
  2. Hormonal management: essentially all forms of birth control with hormones
    1. birth control pills, birth control patches, vaginal birth control rings
      1. these options are great because you have control. If you don’t like how you feel then you can stop the medication immediately and reach out to your doctor.
      2. These are all great options for birth control as well so there is the added benefit of contraception. 
      3. These options all have two active hormones: Estrogen and Progesterone. If you have high blood pressure, smoke or have severe migraines you may not be able to use these medications because of the side effects. Always disclose any medical conditions to your doctor even if you think it is already listed in your medical records.
  3. Hormone imbedded intrauterine device (IUDs) and hormonal implants (Nexplanon)
    1. these are hormone releasing devices that a doctor has to either place inside your uterus (MIRENA IUD) or insert into your upper arm (Nexplanon). Again, they not only can help with symptoms of endometriosis but are some of the most effective forms of contraception.
    1. Both of the options listed above only supply progesterone
  4. Non-estrogen containing options
    1. besides the IUD and Nexplanon there are also other progesterone-only pills that can help with endometriosis related pain. There are many different types, therefore, a thorough discussion with your medical provider is essential in choosing the right option for you.
  5. Medicines that work on hormone production
    1. Lupron: this medication can be given for a few months at a time and can temporarily stop hormone production in the ovaries.
    2. Orilissa: this is the newest endometriosis-specific medication on the market. It works to decrease the amount of estrogen in your body in the hopes that this will lessen endometriosis symptoms.

There are many options available to women with known or presumed endometriosis. Choosing the right option requires careful consideration of the symptoms and the impact on daily activities. Remember to discuss all your previous medical conditions with your health care provider before choosing a new medication.

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