When it comes to treating endometriosis, there are a number of options that can be offered. There are many factors involved in the process of deciding which treatment is the right choice.
The age of the patient can often be one of the biggest factors in deciding the treatment path. For a younger patient without children, preserving and optimising fertility will be one of the biggest considerations, however for women who are later in their life and do not want any/any more children there will be other treatment options which may affect fertility. For example, when endometriosis is diagnosed in teens many doctors want to take a more conservative approach to treatment as they could still be growing, and many of the drug treatments can damage growing bones. There are so many other factors and considerations that come in to play when treating teens with endo, and as endo diagnoses are usually given later in life there is not as much information to work from. Because this is quite a complicated area, I will be doing another blog post at a later point discussing the treatment options and considerations for teenagers with endometriosis.
Drugs are a popular option for endometriosis treatments as, in the majority of cases, their effects are only there for as long as you are taking the medication, these effects can then be reversed by coming off the medication. However, if you are taking medication you can open yourself up to many other side effects. Medication is not a permanent treatment for endometriosis though, as the medications can eventually become ineffective as your body gets used to them and then the symptoms can come back. Some medical therapies will relieve the pain and decrease the inflammation without directly affecting the endometriosis present. Others will directly affect the endometriosis tissue by suppressing its growth and shrinking the implants down to the point that they become inactive. It is important to remember that no medication currently available can totally eliminate endometriosis, but they can be used to alleviate some of the symptoms.
Two of the most popular medical therapies are drugs that mimic pregnancy and menopause. Both of these therapies work, because they trick the body into stopping the natural menstrual cycle, which in turn affects the hormonal cycle that for most people can be a big factor in levels of endo related pain.
As well as hormonal medical therapies, NSAIDs are another common form of endometriosis treatment. This is any form of Non Steroidal Anti Inflammatory Drug such as ibuprofen, naproxen or mefenamic acid. These can be a great starting point, as their anti inflammatory properties can help to decrease the inflammation that causes scar tissue – but, as with other drug treatments, they don’t have any affect on adhesions and scarring that are already present.
Surgery is another option for treating endometriosis, and unlike the drug therapies, something can be done about the adhesions and scarring that is already present. Sometimes during your diagnosis surgery, the surgeon will treat the endometriosis they find to prevent you from needing an additional surgery, but if it is too complex or in a difficult area to dissect from then they may need to schedule another surgery with a specialist in endometriosis in that specific area. There are two ways of removing the endometrial tissue that are most commonly used – excision and ablation, and there is a lot of discussion over which is the better method of treatment.
Excision is where the entire endometrial lesion is removed. Think of gardening, and when you remove the weed you dig it up from the roots cutting it off at the source and preventing that specific weed from re-growing from its roots. But, it does not guarantee you that a completely different weed will not grow in its place.
Ablation is where the endometrial lesion is removed from the surface by burning it off. Back to the gardening analogy, but this time you just get rid of the weed that you can see above the surface of the ground by burning it off. This leaves the roots of the weed completely intact, and it is quite likely that the weed will regrow.
Doctors and patients each have their preferences, and their own reasons, for their treatment choices. But, the one piece of universal advice I would give to everyone is to ask as many questions as possible, and make sure you completely understand, and are completely happy with your treatment plan. If you would rather have a different form of treatment, ask for it! Make yourself heard, and ensure that your doctor is aware of your preferences.
As with many things endo related, there is so much more information that I could give, but I don’t want to turn this blog post into something that would rival my dissertation, so I’m going to read it here. I have been reading a book where the section on endometriosis treatments is over 100 pages, so I will definitely be sharing the rest of the information that I find across many more blog posts!