Endometriosis: care and treatment


בריאות, הבלוג של המגזין, טיפים לבריאותכם / יום שני, דצמבר 31st, 2018

Treatment for endometriosis is usually done via medication or surgery. The approach that you and your doctor will choose will depend on the severity of your symptoms and whether you are looking for a pregnancy or not. Doctors generally recommend trying conservative therapeutic approaches first, opting for surgery as a last resort.

Pain medications
Your doctor may advise you to take a painkiller without a prescription, such as an anti-inflammatory (NSAID), non-steroidal ibuprofen or naproxen, to help alleviate painful menstrual cramps. However, if taking the maximum dose does not completely reduce the pain you may need to try another approach to managing the symptoms.

Hormone therapy
Additional hormones are sometimes effective in reducing or eliminating pain. This is because the rise and fall of hormones during the cycle causes endometrial implants to thicken, break and bleed. Hormonal medication can slow down its growth and prevent new endometrial tissue implants.

However, hormone therapy is not a permanent solution for endometriosis. Recurrence may occur after stopping treatment.

Hormone therapy used to treat endometriosis includes:

Hormonal contraceptives . The contraceptive pill , the patch and the vaginal rings help to control the hormones responsible for the accumulation of endometrial tissue every month. Most women have a lighter and shorter menstrual flow if they use a hormonal contraceptive. Using hormonal contraceptives – particularly in a continuous-cycle regimen – can reduce or eliminate mild to moderate endometriosis.
Gonadotrophin-releasing hormone (Gn-RH) agonists and antagonists . These drugs block the production of hormones that stimulate the ovaries, lowering estrogen levels and preventing menstruation. This causes the endometrial tissue to shrink. Gn-RH agonists and antagonists can force endometriosis to go into regression during the treatment period and sometimes even months and years after suspension. Because these drugs create an artificial menopause, taking a low dose of estrogen or progestogens together with Gn-RH agonists can reduce the side effects of menopause such as hot flashes, vaginal dryness and loss of bone. Your menstrual cycles and the chance of getting pregnant will return when the drug is stopped.
Medroxyprogesterone (Depo-Provera) . This injectable drug is effective in blocking menstruation and growth of endometrial implants, thus alleviating signs and symptoms of endometriosis. Its side effects may include weight gain, reduced bone production, depression and others.
Danazolo . This drug suppresses the growth of the endometrium by blocking the production of hormones produced by the ovaries, preventing menstruation and symptoms of endometriosis. However, danazol may not be the first choice of treatment as it can cause serious side effects and may be harmful to the child if they become pregnant.
Conservative surgery
If you have endometriosis and are trying to get pregnant, surgery to remove as much endometriosis as possible while preserving your uterus and ovaries (conservative surgery) can increase your chances of success. Even if you have severe pain caused by endometriosis you can benefit from surgery, however endometriosis and pain may remain. The doctor can do this procedure laparoscopically or with traditional abdominal surgery in the most extensive cases. In laparoscopy the doctor inserts a long and thin instrument with a camera to remove the endometrial tissue through a small incision.

Assisted reproduction techniques
Assisted reproduction techniques such as in vitro fertilization can help you get pregnant and are sometimes better than conservative surgery. Doctors suggest this kind of approach if conservative surgery is ineffective.

Hysterectomy
In the most severe cases of endometriosis the best treatment can be to remove the uterus, the cervix and both ovaries (total hysterectomy). The only hysterectomy (removal of the uterus) is not effective, the estrogen that the ovaries produce can stimulate any remaining endometriosis to cause pain. Hysterectomy is generally considered the last resort, especially for women of reproductive age. You can not get pregnant after a hysterectomy. Finding a doctor with whom you feel comfortable is essential in the management and treatment of endometriosis. It is also advisable to ask for a second opinion before starting any treatment to make sure you know all the options and possible outcomes.

Lifestyles and home remedies
If the pain persists or if you take time to find a treatment that works, you can try home remedies to relieve the pain:

Hot baths and a hot water bottle can help relax the pelvic muscles, reducing cramps and pains.
Prescription drugs and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help alleviate cramps.
Making constant exercise helps improve symptoms.
Natural remedies
Some women say that thanks to acupuncture, pain decreases. However, research is still poor in the su

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