Endometriosis - what are my treatment options?
- 24 Aug 2010 by Anonymous
- 28 Aug 2010
- endometriosis, hysterectomy, pain, hormone replacement therapy
I suffer from very severe endo, and even after a complete hysterectomy, I still have... constant pain. My gyno tells me that I need to go off my hormones, which may help suppress the endo. But when I do this, I am an emotional wreck.
Does anyone have any suggestions? Because my doc doesn't give me a whole lot of info or options. I mean, are those my only options? Hormones or no? Aren't there different types?
While there is no cure for endometriosis, in many patients menopause (natural or surgical) will abate the process. In patients in the reproductive years, endometriosis is merely managed: the goal is to provide pain relief, to restrict progression of the process, and to restore or preserve fertility where needed. In younger women with unfulfilled reproductive potential, surgical treatment attempts to remove endometrial tissue and preserving the ovaries without damaging normal tissue. In women who do not have need to maintain their reproductive potential, hysterectomy and/or removal of the ovaries may be an option; however, this will not guarantee that the endometriosis and/or the symptoms of endometriosis will not come back, and surgery may induce adhesions which can lead to complications.
In general, the diagnose of endometriosis is confirmed during surgery, at which time ablative steps can be taken. Further steps depend on circumstances: patients without infertility can be managed with hormonal medication that suppress the natural cycle and pain medication, while infertile patients may be treated expectantly after surgery, with fertility medication, or with IVF.
Progesterone or Progestins: Progesterone counteracts estrogen and inhibits the growth of the endometrium. Such therapy can reduce or eliminate menstruation in a controlled and reversible fashion. Progestins are chemical variants of natural progesterone.
Avoiding products with xenoestrogens, which have a similar effect to naturally produced estrogen and can increase growth of the endometrium.
Hormone contraception therapy: Oral contraceptives reduce the menstrual pain associated with endometriosis. They may function by reducing or eliminating menstrual flow and providing estrogen support. Typically, it is a long-term approach. Recently Seasonale was FDA approved to reduce periods to 4 per year. Other OCPs have however been used like this off label for years. Continuous hormonal contraception consists of the use of combined oral contraceptive pills without the use of placebo pills, or the use of NuvaRing or the contraceptive patch without the break week. This eliminates monthly bleeding episodes.
Danazol (Danocrine) and gestrinone are suppressive steroids with some androgenic activity. Both agents inhibit the growth of endometriosis but their use remains limited as they may cause hirsutism and voice changes.
Gonadotropin Releasing Hormone (GnRH) agonist: These agents work by increasing the levels of GnRH. Consistent stimulation of the GnRH receptors results in downregulation, inducing a profound hypoestrogenism by decreasing FSH and LH levels. While effective in some patients, they induce unpleasant menopausal symptoms, and over time may lead to osteoporosis. To counteract such side effects some estrogen may have to be given back (add-back therapy). These drugs can only be used for six months at a time.
Lupron depo shot is a GnRH agonist and is used to lower the hormone levels in the woman's body to prevent or reduce growth of endometriosis. The injection is given in 2 different doses a once a month for 3 month shot with the dosage of (11.25 mg) or a once a month for 6 month shot with the dosage of (3.75 mg).
Aromatase inhibitors are medications that block the formation of estrogen and have become of interest for researchers who are treating endometriosis.
NSAIDs Anti-inflammatory. They are commonly used in conjunction with other therapy. For more severe cases narcotic prescription drugs may be used. NSAID injections can be helpful for severe pain or if stomach pain prevents oral NSAID use.
MST Morphine sulphate tablets and other opioid painkillers work by mimicking the action of naturally occurring pain-reducing chemicals called "endorphins". There are different long acting and short acting medications that can be used alone or in combination to provide appropriate pain control.
Diclofenac in suppository or pill form. Taken to reduce inflammation and as an analgesic reducing pain.
Well taliecakes, I don't know how old you are, but I had huge problems with this and fibromyalgia when I was younger. My troubles with endo improved with the onset of menopause, but I still suffer from fibro. Do you know if you also have this problem. I used to talk with a lot of women when I had my jewelry shop, and from all my discussions, I discovered that many women who suffer from "female problems" like endo, also have fibro. It can be very hard to tell where the endo pain leaves off and where the fibro begins however. If I were you, I would speak with my doctor about the possibility of my having fibromyalgia, or at least do some research into it on my own. On second thought, you may scare your doctor off if you bring this up, as most doctors that I've spoken with are very nervous at the prospect of dealing with patients who have serious and continuing pain issues.
It actually might make the most sense for you to look into this yourself, and if you believe you may have some of the symptoms then go to a doctor that specializes in fibro. Generally speaking, they would probably have a better handle on dealing with the continuous pain problems that people like myself (and possibly you) have. I hope this at least gives you some ideas, keemo7
I am not sure what type of pain you are having, could you be more descriptive? I too had endometriosis and a complete hysterectomy only to still be in pain. I thought I was crazy and went from OBGYN to OBGYN. Finally I found a really good one that properly palpitated and discovered that most of my pelvic muscles were very taunt and tight. He sent me to a physical therapist who had been trained on how to relieve the pelvic muscle "trigger points" is what they call them and it is related to fibromyalgia. All I can tell you that it is brought on by all the surgeries and the way that you carried yourself when you are in pain. It is hard to relax when you are in pain and those muscles are not muscles that you normally pay any attention to. I found a book called "A headache in the pelvis" I think that is the name, but apparently men suffer from the same problem.
It is worth checking out and if it is the problem could save you the four to five years it took me to get it figured out. I wish you the best of luck and no matter what, know that you are not crazy and the pain is "real." It may have nothing to do at all with your hormones which means you get to take the ones that actually work for you.
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