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Treatment of Endometriosis
Treatment depends on the age of the patient, severity of the symptoms and the extent of the disease and her desire for conception. Women with mild symptoms may just be monitored and examined regularly to see for the progression of the disease. The different
modes of treatment are-
- Medical therapy
- Surgical therapy
This is usually indicated in patients with minimal endometriosis.
Analgesic or anti-inflammatory drugs
These drugs are mainly used for symptomatic relief in women with mild pain. Some of the commonly used drugs are Aspirin, Ibuprofen and naproxen sodium. The pain in endometriosis may also be releived by the following treatment-
- High frequency TENS,
- Vitamin B1
Danazol is a derivative of the male hormone testosterone. It acts by Suppressing ovulation and thereby preventing production of hormones that would bring about growth of the endometrial implants and pain. This leads to atrophy of the endometrial implants.
The common side effects are, weight gain, hirsutism, hot flushes, insomnia, depression, irritability, mood changes and voice changes.
Oral contraceptive pills
These drugs act by suppressing ovulation (Production of egg by the ovaries). As a result, there is reduction in the production of the hormone oestrogen by the ovaries leading to shrinkage of the endometrial implants.
The common side effects are, weight gain, breast tenderness and nausea
GnRH agonists (gonadotropin releasing hormone agonists)
These drugs act by suppressing menstrual periods (Artificial menopause), thereby suppressing the production of oestrogen and shrinkage of the endometrial implants.
The common side effects are-hot flushes, dyspareunia, vaginal dryness, loss of libido and mood swings. Long-term use may lead to bone loss and osteoporosis.
Medroxyprogesterone acetate (Depo-provera)
Produces shrinkage of the endometrial tissue by suppressing ovulation and menstruation and thereby suppressing the production of oestrogen.
The common side effects are, breast tenderness, uterine bleeding, and depression.
Surgical treatment is usually indicated if endometriosis is extensive, with distortion of the pelvic anatomy. This can be conservative (where the pelvic anatomy is restored) or radical (removal of the reproductive organs.
Laparoscopy- is a key hole procedure, where a fiber optic tube with a small lens is introduced into the abdomen through small incisions. It is a very useful procedure not only to diagnose endometriosis, but also to treat it. Adhesions can be lysed using sharp and blunt dissection, endometrial lesions can be cauterised, endometriomas (endometriotic cysts in the ovary) can be removed and laser can be used to vaporise the endometriotic implants.
Laparotomy- is a procedure where the abdominal cavity is visualised after making an incision over the abdominal wall. It is usually performed for a more extensive surgery Endometrial lesions are destroyed, adhesions released, large endometriomas are removed and repair of any damaged organs is done.
Hysterectomy(removal of the uterus) and bilateral salpingo-ophorectomy (removal of fallopian tubes and ovaries) is the definitive treatment for endometriosis. This is done as a last resort in women with long standing endometriosis, those with severe pain and those who do not respond to other forms of treatment.
Before going for surgery use the following strategies to help you recover better. These include-
Have a healthy diet with plenty of fruits vegetables and fibre. Try and avoid refined sugar.
Have confidence in your surgeon Discus all aspects of the treatment with the surgeon or the nurse.
Use relaxation methods and this help your recovery after surgery.
Spend quality time with your family and loved ones.