How do you treat endometriosis?

Endometriosis is a hormone dependent disease. Endometriosis needs oestrogen to grow. We also know that pregnancy is a fantastic way to get rid of endometriosis. Therefore if you can trick the body into thinking it is pregnant or give drugs to reduce oestrogen you can improve the symptoms of endometriosis. Nearly all of the hormonal medications used to treat endometriosis are also contraceptive (prevent pregnancy).

Oral contraceptive pill – all of the oral contraceptive pills can improve the pain of endometriosis. There are lots of different types of pills (known as OCPs – oral contraceptive pills). OCPs contain oestrogen and progesterone. Often gynaecologists will recommend taking three packets in a row – skipping periods for three months. This is very safe and means that the pain of a period only happens 4 times a year. This can be particularly helpful for women in Year 11 or 12 where avoiding the severe pain of menstruation is essential to get through exams.

Progesterone only preparations
Progesterone only medication can be very helpful in improving the pain of endometriosis. There are many different types of progesterone only medications. All work in a similar way to improve pain – they thin the lining of the womb so that there is less tissue to flow backwards out the tubes and make new deposits. They also thin the deposits that already exist in the pelvis and trick the body into thinking it is pregnant. There are progesterone only pills such as the “minipill” or a tablet called primolut or provera.
There is a progesterone implant called implanon. This has the added benfit of being contraceptive. Unfortunately in 20% of women it will cause irregular vaginal bleeding which can be annoying.
There is a progesterone injection called depot provera. This can be fantastic in some women as it stops their periods. The down side of the injection is that it can cause problems for some women who want to fall pregnant. Even months after it is given women can have trouble ovulating (releasing an egg) so it is not a good choice for a woman who is planning to get pregnant in the future.

Visanne – this is a newer progesterone only medication which is very helpful in reducing pain of endometriosis. The biggest problem is the cost – it is not on PBS (the government medication schedule) so costs around $80 per month.

Mirena IUD – an IUD is an intrauterine device. It is a plastic T shaped device which a gynaecologist puts into the uterus. It contains low dose progesterone that is delivered exactly where it is needed – into the uterus and pelvis. Mirena can be excellent in reducing pain of endometriosis. It is also contraceptive, once it is removed fertility returns quickly to normal. Mirena makes periods much lighter and in 50% of women they will not have periods at all.

Menopause inducing medication
The only “cure” for endometriosis is menopause. When the body has no oestrogen left the endometriotic deposits will shrink. There are some medications which cause a chemical menopause. Some examples are zoladex – an implant injected each month or synarel – a spray put in the nose each day. The problems with these medications is that they cause menopausal side effects – hot flushes, poor mood and importantly – thinning of bones. Sometimes your doctor will prescribe some addback hormones such as HRT to decrease the side effects. Because of the serious side effects these medications are only used for a short time.
NSAIDs – This stands for non steroidal anti inflammatory drugs. A common example is ibuprofen or nurofen. These medications can reduce period pain. The best way to take them is the day before the period is due and to take them regularly during the period. E.g. ibuprofen 400mg every 8 hours with food. Another excellent NSAID is ponstan or mefenemic acid. The best dose is 500mg (2 tablets) every 8 hours with food.