Sorry for my absence, but well… it’s Christmas! Now that the year is over, I’m ready to get settled back into a routine. Which will hopefully include posting every few days.
Tonight I’d like to cover the treatment options that modern medicine has to offer women with endo. These include GnRH analogs, pain killers, birth control, surgery, hysterectomy, and pregnancy. I personally find it sad and appalling that the last two are even considered treatment options, even though at one point I wanted a hyster.
GnRH (gonadotropin releasing hormone) analogs include drugs such as Buserelin, Goserelin, Leuprorelin, Naferelin, and Triptorelin. The drug I was on, Lupron, is a brand name of Leuprorelin. I was lucky in that I did not have many side effects.
GnRH analogs work by decreasing the production of estrogen by the body, which in theory “starves” the endometrial implants, as they are thought to be dependent on estrogen. This also succeeds in putting the body into a menopausal state, complete with all of the menopausal symptoms.
Perhaps the most serious side effect of GnRH analogs is the bone loss. Lupron’s website will have you believe that an average of only 3% bone loss occurs, according to a private study funded by Abbott Laboratories, the makers of Lupron. In truth, Lupron causes closer to 48% bone loss on average. Because of this, many health care professionals will only prescribe it for a 6 month period. What good is 6 months compared to a lifetime of pain?
Pain killers, in the form of NSAIDs, analgesics, and opioids, are often prescribed to mask the pain. For many women, this is the only thing that modern medicine can offer long term to help them. These do not treat the disease, just one (or maybe two, in the case of NSAIDs) symptoms.
NSAID stands for non-steroidal anti-inflammatory drug, and includes drugs such as Ibuprofen, Naproxen, and Voltaren. The problem many people have with painkillers (besides addiction), is that they wait too long to take them. Painkillers should be taken when you first feel pain in order to block it. The longer you wait, the less effective they are. The big risks with pain killers are ulcers and gastrointestinal hemorrhaging. For most people, this is not a problem when taken correctly.
Some women have even been instructed to begin taking NSAIDs before something painful is about to happen. For many women, this equates to taking them a day before their period starts, and continuing through its duration. For others, this means taking them an hour or two before sex. So much for the element of surprise.
Birth control comes in many forms, and all of them purport to have beneficial effects for endometriosis sufferers. These drugs work by increasing the level of progesterone, and decreasing the level of estrogen in the body, as would happen during pregnancy. Because many women with endo have imbalanced levels of progesterone and estrogen, birth control has the effect of balancing (somewhat) these levels, and is thought to slow the growth of the lesions.
Some forms of birth control include Depo Provera shot, Nuvaring vaginal ring, Mirena IUD, Ortho Evra patch, Implanon implant, and numerous pills (Ortho Tricyclen, Lybrel, Seasonique, Yaz, Loestrin, etc). All of these work essentially the same way, and have the same side effects. They can cause blood clots, sometimes life threatening. Since they effect hormones, they can also lead to mood swings and depression.
Surgery is the only definitive way for anyone to be diagnosed with endometriosis. Usually it is through laparoscopy, but occasionally so much endometriosis is found that a laparotomy is needed to clean out the abdominal cavity. Many doctors will try their best to excise or oblate any lesions they find, but most of them do not have the necessary skill, experience, or knowledge to get it all. There are a few doctors who claim to have an 80% success rate in healing endo patients. Most women end up having a recurrence of symptoms within the first year after surgery.
Sadly, hysterectomy is often suggested to women for whom doctors feel they can do nothing more to help. Unfortunately for these women, up to 1/3rd of them will have a recurrence of symptoms. Since endo is thought to stem from the reproductive system, usually occurs on the outside of the uterus, ovaries, and pouch of Douglas, and is “fed” by the ovaries, many doctors are at a loss when these symptoms reappear. Hysterectomy results in early menopause and bone loss, so should not be undertaken lightly.
Pregnancy is recommended by some doctors as a treatment. Women usually have a lessening of symptoms during pregnancy and breastfeeding, but once the child is weaned, the symptoms return. It is appalling to me that any doctor would suggest a woman bring a life into the world just to lessen her symptoms for 2 years, especially if that woman never wanted children.
We are still in the dark ages with regards to understanding and treatment of this disease, but I hope that something definitive comes along soon.
Endo Sucks 