Medically Reviewed by W. Brad Campbell, MD
The causes of endometriosis, the growth of uterine lining cells outside the uterus, are still unknown. Yet, there are a few treatments that seem to work.
Here are highlights of the comments from Drs. Hardenbergh and Campbell:
- There are no great treatment options, such as “I’m going to take a pill with no major side effects that will magically remove the pain.” Unfortunately, many women have frequent surgeries.
- There is good evidence that a diagnostic laparoscopy, where you ablate or destroy the endometriosis, followed by hormonal contraception, can prolong your pain-free interval years longer than without this combination of treatments.
- Your other options include Lupron, which will shut down your ovaries. However, many people take that for a month and decide it’s not for them.
- When I prescribe Lupron for my patients, I also give them “add back” therapy. Lupron works on your hypothalamus – your brain. A lot goes on to make your egg. Your brain has to talk to your pituitary gland. Your pituitary gland has to talk to your ovary. There’s a hormone that constantly comes out of your brain. When you hit puberty, it starts pulsing. And that’s when everything changes.
- So the Lupron tricks the pituitary gland into thinking it’s coming out constantly. Anything that shuts down your ovaries is going to shut down the lining inside your uterus and wherever else it has made its way to.
- With DepoLupron, my patients get great response for their pain symptoms, but it is expensive and it will throw you into menopause unless you take the “add back” therapy.
- Now, you’ll come back out of menopause when it wears off. But if you don’t take “the pill” every day, you’ll have hot flashes and other menopause symptoms.
- So your response to Lupron that gets rid of the pain or a surgical diagnosis are really the only two ways to get a true diagnosis. Sometimes a patient will come in and the symptoms are clearly endometriosis. But the diagnosis options and treatment options are the same – Lupron or surgery.
- Sometimes you can use continuous birth control pills, because birth control pills trick your pituitary gland into thinking it doesn’t need to do anything. So, you’re not going to make an egg. But you’d need to take them continuously. Don’t take the “inactive” pill. You’d take them for 3 months without inducing a progesterone withdrawal or a period.
- Endometriosis is hard to treat. But I have seen good response in really young women just using the birth control pills. It may be because the disease has not progressed as far, but it does seem to work the best in this case.
- For women who’ve had endometriosis for a number of years, I usually try the birth control pills first. There are no side effects, but it doesn’t work as well in this case as Lupron or surgery.
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