Once endometriosis has been diagnosed, your gynaecologist will advise on the best and most suitable treatment options for your condition, depending on the severity of your symptoms, and whether or not you are planning a pregnancy in the future.
For Life speaks to several experts in Singapore to find out more about the different treatment options for women who live with and suffer from this condition.
For mild endometriosis, over-the-counter pain medication such as non-steroidal anti-inflammatory drugs (NSAIDs) to manage the painful cramps, may suffice.
A combination of oral contraceptives and continuous slow release hormonal contraceptives such as progestin-only intrauterine devices and contraceptive implants may be also prescribed as a longer-term strategy.
“These can reduce or eliminate the pain of endometriosis by helping to control the hormones responsible for the build-up of endometriotic tissue each month, thus making periods shorter and lighter,” explains Dr Kelly Loi, Health & Fertility Centre for Women.
- Gonadotropin-releasing hormone (GnRH) agonists
GnRH agonists, which are injected either monthly or every three months, are usually prescribed for short periods of about six months at a time, with several months between treatments if they are repeated.
“GnRH is used to stop the production of certain hormones to prevent ovulation, menstruation, and the growth of endometriosis. However, this treatment sends the body into a ‘menopausal state’, which can cause side effects similar to menopause, including hot flashes, tiredness, problems sleeping, headache, depression, joint and muscle stiffness, bone loss and vaginal dryness,” says Associate Professor Fong Yoke Fai, from Astra Laparoscopic & Robotic Centre for Women and Fertility.
There is also an increased risk of heart complications and bone loss when taking them for longer periods.
Hormone “add-back” therapy to counter-balance GnRH agonists can help reduce side effects. As with all hormonal treatments, endometriosis symptoms can return once women stop taking GnRH agonists.
- Oral progestin medication
Oral progestins like Visanne® (dienogest 2mg) can reduce the effects of oestrogen on tissues such as the endometrium. The ENVISIOeN study, has shown that reducing the growth effect of oestrogen on the endometrium helps reduce pelvic pain caused by endometriosis and improve quality of life.
According to Dr Ma Li, National University Hospital (NUH) Women’s Centre, “The most common side effect from taking dienogests is amenorrhoea or the cessation of menstruation, after about eight months to a year on the medication. This was experienced by 5.9% of women in the study. Some experienced irregular bleeding, such as spotting between periods and reduced flow. A very small percentage of women experienced headaches or mood changes.”
Normal fertility returns within a month or two after stopping the medication, making it a suitable option for women who want to control their endometriosis but also wish to avoid surgery.
Surgery is usually considered for women with severe endometriosis, who have exhausted other treatment options. For women who hope to get pregnant, conservative surgery to remove as much of the endometriosis as possible while preserving the uterus and ovaries, may be prescribed.
“Surgery can help relieve severe pain caused by endometriosis, however the pain may well return unless a hormone treatment like Visanne® is used to control it,” says Dr Arthur Tseng from Arthur Tseng Women’s Health Services.
These days, surgery is done laparoscopically, although traditional abdominal surgery may be required in very severe and extensive cases.
“If pregnancy is the woman’s primary concern, assisted reproductive technologies such as in-vitro fertilisation (IVF) might be preferable to conservative surgery. Once the woman has had a baby she can then have surgery and/or hormonal treatments to manage the endometriosis,” adds Dr Tseng.
For very severe cases, a total hysterectomy is usually performed, where the uterus, cervix and both ovaries are removed. This is typically considered a last resort for women in their reproductive years.
While each of these options offer women a good chance at controlling or eliminating their endometriosis and regaining control of their lives and health, women with endometriosis must come to terms with the fact that they will need to monitor and manage the disease for their entire reproductive life span.
Since there is currently no cure for endometriosis, early diagnosis and treatment remain the best way to increase the chances of a successful outcome.
Featured photo by Shutterstock.