Overview Of Hormone Therapy For Endometriosis
Endometriosis occurs when cells from the lining of your womb (uterus) grow in other areas of your body. This can cause pain, heavy bleeding, bleeding between periods, and problems getting pregnant (infertility). There is no treatment for endometriosis, but hormone therapy can stop the condition from getting worse.
Causes Of Endometriosis
Every month, a woman’s ovaries produce hormones that tell the cells lining the uterus to swell and get thicker. Your uterus sheds these cells along with blood and tissue through your vagina when you have your period.
Endometriosis occurs when these cells grow outside the uterus in other parts of your body.
This tissue may attach to your:
- Ovaries
- Fallopian tubes
- Bowel
- Rectum
- Bladder
- Lining of your pelvic area
- It can grow in other areas of the body, too.
These growths stay in your body, and like the cells in the lining of your uterus, these growths react to the hormones from your ovaries. This may cause you to have pain during the month prior to the onset of your period. Over time,the growths may add more tissue and blood. Growths can also build up in the abdomen and pelvis leading to chronic pelvic pain, heavy cycles, and infertility.
No one knows what causes endometriosis. One idea is that when you get your period, the cells may travel backwards through the fallopian tubes into the pelvis. Once there, the cells attach and grow. However, this backward period flow occurs in many women. The immune system may play a role in causing endometriosis in women with the condition.
Endometriosis is common. It occurs in about 10% of women of reproductive age. Sometimes, it may run in families. Endometriosis probably starts when a woman begins having periods. However, it usually is not diagnosed until ages 25 to 35.
You are more likely to develop endometriosis if you:
- Have a mother or sister with endometriosis
- Started your period at a young age
- Never had children
- Have frequent periods, or they last 7 or more days
Symptoms
Pain is the main symptom of endometriosis. You may have:
Painful periods — Cramps or pain in your lower belly may begin a week or two before your period. Cramps may be steady and range from dull to severe.
Pain during or after sexual intercourse.
Pain with urination.
Pain with bowel movements.
Long-term pelvic or low back pain that may occur at any time and last for 6 months or more.
Other symptoms of endometriosis include:
Heavy menstrual bleeding or bleeding between periods
Infertility (difficulty getting or staying pregnant)
You may not have any symptoms. Some women with a lot of tissue in their pelvis have no pain at all, while some women with milder disease have severe pain.
Exams & Tests
Your health care provider will perform a physical exam, including a pelvic exam.
You may have one of these tests to help diagnose the disease:
Transvaginal ultrasound
Pelvic laparoscopy
Magnetic resonance imaging (MRI)
Treatment of Endometriosis
Learning how to manage your symptoms can make it easier to live with endometriosis.
What type of treatment you have depends on:
Your age
Severity of your symptoms
Severity of the disease
Whether you want children in the future
There is currently no cure for endometriosis. There are different treatment options.
PAIN RELIEVERS
If you have mild symptoms, you may be able to manage cramping and pain with:
- Exercise and relaxation techniques.
- Over-the-counter pain relievers — These include ibuprofen (Advil), naproxen (Aleve), and acetaminophen (Tylenol).
- Prescription painkillers, if needed, for more severe pain.
- Regular exams every 6 to 12 months so your doctor can assess the disease.
HORMONE THERAPY FOR ENDOMETRIOSIS
- These medicines can stop endometriosis from getting worse. They may be given as pills, nasal spray, or shots. Only women who are not trying get pregnant should have this therapy. Some types of hormone therapy will also prevent you from getting pregnant while you are taking the medicine.
- Birth control pills — With this therapy, you take the hormone pills (not the inactive or placebo pills) for 6 to 9 months continuously. Taking these pills relieves most symptoms. However, it does not treat any damage that has already occurred.
- Progesterone pills, injections, IUD — This treatment helps shrink growths. Side effects may include weight gain and depression.
- Gonadotropin-agonist medicines — These medicines stop your ovaries from producing the hormone estrogen. This causes a menopause-like state. Side effects include hot flashes, vaginal dryness, and mood changes. Treatment is often limited to 6 months because it can weaken your bones. Your provider may give you small doses of hormone to relieve symptoms during this treatment. This is known as ‘add-back’ therapy. It may also help protect against bone loss, while not triggering the growth of the endometriosis.
- Gonadotropin- antagonist medicine — This oral medication helps lower production of estrogen resulting in a menopausal like state and controls the growth of endometrial tissue resulting in less severe painful and heavy menses.
SURGERY
- Your provider may recommend surgery if you have severe pain that does not get better with other treatments.
- Laparoscopy helps diagnose the disease and can also remove growths and scar tissue. Because only a small cut is made in your belly, you will heal faster than other types of surgery.
- Laparotomy involves making a large incision (cut) in your belly to remove growths and scar tissue. This is major surgery, so healing takes longer.
- Laparoscopy or laparotomy may be a good option if you want to become pregnant because they treat the disease and leave your organs in place.
- Hysterectomy is surgery to remove your uterus, fallopian tubes, and ovaries. Having both your ovaries removed means entering menopause. You would only have this surgery if you have severe symptoms which did not get better with other treatments and do not want to have children in the future.
