Endometriosis happens when the lining of the uterus (womb) grows outside of the uterus. It affects about 5 million American women. Endometriosis is especially common among women in their 30s and 40s; it can create difficulty getting pregnant and can cause infertility.
Pain is one of the most common symptoms of endometriosis. Endometriosis pain happens most often during your period, but it can also happen at other times.
Several endometriosis treatment options are available, and they vary from patient to patient; some can help manage the symptoms and improve your chances of getting pregnant. In some cases, surgery is advised, but in others, it is not.
Symptoms of endometriosis can include:
Endometriosis growths bleed in the same way the lining inside of your uterus does every month — during your menstrual period. This can cause swelling and pain because the tissue grows and bleeds in an area where it cannot easily get out of your body.
The growths may also continue to expand and cause problems, such as:
If you have symptoms of endometriosis, talk with your doctor. The doctor will talk to you about your symptoms and do or prescribe one or more of the following to find out if you have endometriosis:
There is no cure for endometriosis, but treatments are available for the symptoms and problems it causes. Talk to your doctor about your treatment options.
If you are not trying to get pregnant, hormonal birth control is generally the first step in treatment. This may include:
Hormonal treatment works only as long as it is taken and is best for women who do not have severe pain or symptoms.
If you are trying to get pregnant, your doctor may prescribe a gonadotropin-releasing hormone (GnRH) agonist (e.g. Depo Lupron 3.75 mg intramuscularly every month or 11.25 mg every 3 months). This medicine stops the body from making the hormones responsible for ovulation, the menstrual cycle, and the growth of endometriosis. It causes a temporary menopause and also helps control the growth of endometriosis. Once you stop taking the medicine, your menstrual cycle returns, but you may have a better chance of getting pregnant.
Long-term use of GnRH agonists is problematic as they are associated with bone loss. Adults lose 5 – 8 % of bone in the spine after only 3 – 6 months of GnRH agonist treatment. The bone loss can persist after stopping the treatment. We will therefore often prescribe medications that prevent bone loss along with the GnRH-agonist (add-back therapy). Aygestin (northindrone acetate) 5 mg daily prevents this bone loss.
Surgery is usually chosen for severe symptoms, when hormones are not providing relief or if you are having fertility problems. During the operation, the surgeon can locate any areas of endometriosis and may remove the endometriosis patches. After surgery, hormone treatment is often restarted unless you are trying to get pregnant.
Other treatments you can try, alone or with any of the treatments listed above, include:
To see a fertility specialist with expertise treating endometriosis and infertility, schedule an appointment at one of InVia's four Chicago area fertility clinics.
Dr. Karande is Board Certified in the specialty of Obstetrics and Gynecology as well as the subspecialty of Reproductive Endocrinology and Infertility. He is a Fellow of the American College of Obstetricians and Gynecologists and Member of the American Society for Reproductive Medicine.
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