Surgical and Medication Treatment Options for Endometriosis
Endometriosis is a disorder in which tissue, similar to the tissue that lines the uterus, grows outside the uterus in places where it doesn't belong. This tissue thickens, breaks down and bleeds with each period.
Painful periods can happen with endometriosis. There may be heavy bleeding or pain during sex or when having a bowel movement or urinating. Having trouble getting pregnant is also common with endometriosis.
Minor surgery to remove endometriosis deposits can help in cases of severe pain. Medications and hormone therapy may ease symptoms.
Surgical Treatments
Excision surgery is considered the gold standard for treatment of endometriosis. It involves the complete removal of endometrial tissue and is considered a long-lasting treatment for endometriosis, especially for severe cases. Here’s why:
• Complete Removal of Endometriosis Tissue: Excision involves the surgical removal of endometrial tissue, rather than just destroying it (like in ablation). This allows the surgeon to target and remove all the affected tissue, even deep lesions. This thorough removal is more likely to reduce the recurrence of symptoms compared to ablation.
• Long-Term Pain Relief: Because excision surgery removes the endometrial tissue at its root, many women experience longer-lasting relief from pain and other symptoms. This can improve quality of life and may prevent the recurrence of severe symptoms for several years.
• Better Fertility Outcomes: Excision surgery is particularly beneficial for women with endometriosis-related infertility. By completely removing endometrial growths that may be blocking or damaging reproductive organs, it can improve the chances of conception. Studies suggest that excision provides a higher success rate for women trying to conceive compared to other treatments.
• Prevents Scar Tissue (Adhesions): While any surgery carries a risk of scarring, excision is less likely to cause excessive adhesions compared to other procedures like ablation. This is important because adhesions can cause additional pain or fertility issues.
• Reduced Recurrence of Symptoms: Excision surgery is more effective in preventing the recurrence of symptoms, especially in severe cases, because it removes the tissue completely rather than leaving remnants behind that can cause the condition to flare up again.
Ablation Surgery typically refers to a procedure where the tissue affected by endometriosis is destroyed using heat or laser. However, many medical professionals do not consider it the best treatment because:
• Incomplete treatment: Endometriosis can affect areas deep within the pelvic cavity or organs, and ablation may not remove all the affected tissue. If endometrial tissue is not fully excised, it can lead to the recurrence of symptoms over time.
• Temporary symptom relief: While ablation can provide temporary relief from pain, it doesn't address the underlying cause of the condition. The endometriosis may return, leading to a recurrence of symptoms.
• Scarring risk: The procedure may cause scarring or adhesions in the pelvic region, which can lead to more pain, infertility, or complications during future surgeries.
• Not always suitable for severe cases: In more severe cases of endometriosis, where lesions are deeply embedded in the pelvic organs - ovaries, the bowel, or bladder - ablation may not be effective. In these cases, more invasive surgery like excision where the tissue is cut out, may be needed.
• Possible fertility issues: Although ablation may be effective in controlling pain, it can impact fertility. If the endometrial tissue is ablated in areas that affect reproductive organs it can lead to complications for women trying to conceive.
Should you use an intrauterine device (IUD) after endometriosis surgery?
The severity of your endometriosis, your symptoms and your reproductive goals will enter in to the decision to use or not use an IUD after surgery.
• Symptom Management: If your endometriosis symptoms are related to hormone fluctuations, particularly pain during menstruation, a hormonal IUD, like Mirena, may be recommended.
• Contraception: An IUD can be a convenient and long-term option post-surgery. The hormonal IUD can also provide reduce endometriosis-related pain, as mentioned above.
• Fertility Considerations: An IUD is not typically recommended for women trying to conceive. However, after excision surgery, some women may temporarily use it to manage symptoms while on fertility treatments. Doctors may advise against using an IUD if you plan to become pregnant in the near future.
Other forms of hormonal therapy can work similarly to an IUD in terms of reducing symptoms. The decision to use an IUD after endometriosis surgery should be made in consultation with your doctor.
Medication Treatments
Myfembree is used to treat for pain associated with the condition. It contains two active ingredients: Elagolix (a GnRH antagonist) and Estradiol (an estrogen) combined with Norethindrone Acetate (a type of progestin).
Its’ benefits include symptom relief and bone density protection. It is taken in pill form. Its’ side effects may include hot flashes, headaches, fatigue and changes in menstrual bleeding. As with any hormonal treatment, long-term use may have effects on bone health. But the presence of estrogen in Myfembree helps mitigate this risk better than other medications that suppress estrogen completely. Myfembree is typically prescribed for up to 24 months. It’s important to consult with your doctor for specific recommendations based on your individual situation.
Lupron (leuprolide acetate) and Orlissa (elagolix) are used to manage endometriosis-related symptoms, but they work in different ways.
Lupron, typically given as an injection, suppresses the release of gonadotropins (LH and FSH) from the pituitary gland creating a medically induced menopause, leading to a significant decrease in estrogen levels to help reduce endometrial growth and pain.
Orlissa taken orally, inhibits the action of GnRH (gonadotropin-releasing hormone), leading to a decrease in estrogen production. It is more targeted compared to Lupron and doesn't completely shut down the ovaries, making it less likely to cause severe menopausal symptoms.
Side Effects for Lupron and Orlissa may include hot flashes, night sweats, headache, mood swings, and decreased bone density with prolonged use. Both medications suppress estrogen, leading to menopausal-like symptoms, but Lupron tends to cause more intense symptoms. Orlissa is generally associated with fewer menopausal-like side effects and may be more tolerable. Both medications suppress fertility as they stop ovulation and menstruation. Fertility typically returns once the medications are stopped. Long-term use may make it harder to conceive. Orlissa is considered slightly less likely to impact fertility long-term compared to Lupron.
Both medications can be expensive, and out-of-pocket costs depend on insurance coverage. Lupron often involves higher costs because it requires monthly or quarterly injections, or implants. Orlissa, being an oral medication, might be more affordable in comparison but can still be costly if not fully covered by insurance.
Lupron is typically prescribed for a shorter duration, usually 3 to 6 months, to minimize the long-term side effects associated with estrogen suppression, particularly bone density loss.
Orlissa is often prescribed for 6 to 12 months. Like Lupron, long-term use is generally avoided due to side effects, though Orlissa tends to have a more favorable profile for shorter-term use.
If you are one of the many women dealing with endometriosis and its symptoms, call Solstice Physiotherapy at 929-269-2505 or email us to schedule a free 15-minute consultation to discuss your concerns and learn about how we may be able to help improve your quality of life.