Synthetic Progesterone Or Progestins
These may be used instead of the combined oral contraceptive pill. Progestins can be helpful for managing endometriosis because they help to thin the endometrium lining, suppress ovulation, reduce circulating levels of estrogen and can decrease inflammation.3
Examples of synthetic progesterone medications include:
- Norethindrone acetate
- Medroxyprogesterone acetate
- Intrauterine systems with levonorgestrel
Micronised progesterone is natural progesterone and is an alternative to synthetic progestins. The brand name commonly used is Prometrium. However, using progesterone for suppression of endometriosis requires high doses which lowers estrogen, resulting in bone loss if used long term.
Medical Treatment Of Endometriosis
All eight guidelines recommend progestins as first-line medical treatment for pain in endometriosis. In this paragraph we try to investigate the different types and ways of administration of progestins on the treatment of endometriosis.
Dienogest is 19-nortestosterone derivative, a fourth generation orally active progestogen with a high specificity for the progesterone receptor . The most common used dosage, 2 mg per day, causes only a minimal reduction of the estrogen levels, thus, none hypoestrogenic side effect is described . WES and S2k recommend dienogest prior to other progestines. S2k and CNGOF underline, that in two RCTs the administration of dienogest showed comparable efficacy to GnRH-analogues with better tolerability .
Medroxyprogesterone acetate, a 17OH-progesterone derivative, is commonly used as a three monthly intramuscularly or subcutaneously administered contraceptive method . It belongs to first line therapies for endometriosis-associated pain according to the two American societies, the Canadian society and ESHRE. The evidence grade varies between the above societies. WES underlines the weak evidence grade and classifies the above therapy as a second line treatment.
Medroxyprogesterone acetate seems to be an effective and very economical therapy in relieving endometriosis-associated pain, with substantially less bone loss than GnRH agonists .
Combined Oral Contraceptives Pills
Hormone Therapy As A Treatment For Endometriosis
Endometriosis is a very common reproductive disorder that affects about one in ten women in the United States during their childbearing years. Unfortunately, the most common complaint when it comes to endometriosis is pain, which can have a serious impact on your quality of life.
If you find yourself among the millions of women who struggle with endometriosis, hormone therapy may provide the perfect solution. At Advanced Endometriosis Center, as our name suggests, Ulas Bozdogan, MD, and our team understand the many ways that endometriosis can affect your life.
As if the pain werent enough, endometriosis can also lead to difficulties with fertility, gastrointestinal issues, and irregular periods. To put an end to these symptoms and restore your quality of life, explore how hormone therapy may hold the key to solving your endometriosis issues.
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Continuous Estrogen/progestin Hormonal Therapy
Medications containing a combination of an estrogen and a progestin can be used to control your periods and suppress the activity of endometriosis. The most common combination of estrogen and progesterone is in the form of the birth control pill, but hormones can also be delivered by a vaginal contraceptive ring that lasts 3-4 weeks or a patch that you wear on your skin and change weekly. All hormonal medications appear to be most effective against endometriosis when used in a continuous fashion. This means that you use an active pill, ring, or patch daily, and skip the hormone-free week when you would normally have your period.
Instructions on How to take ContinuousCombined Hormonal Therapy
- Birth Control Pills – Take one active pill every day at the same time
- Vaginal Ring – Insert a new vaginal ring every 3-4 weeks
- Patch – Change your patch weekly
Continuous use is as easy as skipping the inactive pills in your pill pack or replacing your ring/patch as soon as it would normally be time to remove the old one. In doing so, you will decrease the number of bleeding days that you have and prevent pain associated with your period.
Hormonal Treatments In Clinical Use Are:
- Hormonal contraceptives
- GnRH agonists / antagonists
- Aromatase inhibitors
It is important to note that medical treatment in endometriosis is focussed on managing pain and symptoms. Medical treatment should not be prescribed to improve fertility. Choosing a medical treatment can be trial and error, it depends on the type and nature of pain, type and nature of bleeding, the efficacy and side effects of the treatment and the preferences of the patient.
Endometriosis lesions react to the hormonal cycle, the basis of treatment with hormonal treatments is to help suppress the activity of the lesions and thus reduce the pain symptoms.
In the general population of women operated upon for endometriosis, including ovarian cystectomy for endometrioma, clinicians should advise postoperative use of a levonorgestrel-releasing intrauterine system , or combined oral contraceptives for at least 1824 months, as one of the options for the secondary prevention of endometriosis-associated dysmenorrhea this does not have proven benefit for the secondary prevention of non-menstrual pelvic pain or dyspareunia. These recommendations are only relevant if the patient is not trying to conceive.
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How Does Hormonal Treatment Work
Hormonal treatment works by temporarily turning off your ovaries so you dont ovulate . When you dont ovulate, you dont have regular periods. When you are prescribed hormonal treatment continuously, you will rarely have periods or not have them at all. Since bleeding can cause pain for anyone with endometriosis, stopping your period will usually improve your pain. Hormonal treatment includes the Pill, vaginal ring, an injection , an IUD or a hormonal patch.
The Combined Oral Contraceptive Pill Or Patch
The combined contraceptive pill and contraceptive patch contain the hormones oestrogen and progestogen.
They can help relieve milder symptoms, and can be used over long periods of time. They stop eggs being released and make periods lighter and less painful. If they are taken back to back they prevent periods and seeding of the lining outside the womb.
These contraceptives can have side effects. Try different brands until you find one that suits you.
Your doctor may recommend taking 3 packs of the pill in a row without a break to minimise the bleeding and improve any symptoms related to the bleeding.
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Choosing Not To Treat Endometriosis
Endometriosis doesn’t always need treatment. Treatment of endometriosis is indicated to treat symptoms or infertility, when your quality of life has suffered.
If left untreated, sometimes endometriosis symptoms will improve, but most will stay the same. Some people will find their symptoms become worse without treatment.
For most women with endometriosis, the symptoms will settle once they go through the menopause. Deciding whether or not to treat endometriosis is often a matter of balancing the risks of the treatment against the effect the endometriosis is having on your life.
Key Points To Remember
- There is no cure for endometriosis. But hormone therapy can help relieve pain. Hormones work for up to 90 out of 100 women. This means that they don’t work for 10 out of 100 women.footnote 1
- Hormone therapy is a good first choice for treatment, unless you want to get pregnant soon. Hormones may reduce the number and size of growths and keep them from spreading.
- When your menstrual periods stop at around age 50 and your estrogen levels drop, endometriosis growth and symptoms will probably also stop.
- Several hormones may be used. You would start with birth control hormones . They are usually the best choice for long-term use until menopause. If they don’t help your symptoms, you could move to a stronger hormone. And if that one didn’t help, you might try an even stronger hormone. The stronger hormones are often used only for a short time, because they have serious side effects.
- If your doctor says it’s okay, you can take non-steroidal anti-inflammatory drugs with or without hormone therapy to help your pain. Be safe with medicines. Read and follow all instructions on the label.
- For some women, hormones reduce pain for only a short time. For others, relief lasts a long time.
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How Will Endometriosis Affect You
While some women never have symptoms, others have severe pain. In some cases, the problem can affect how well your bowels, bladder, or other organs work.
Pain from implants may be mild for a few days before your menstrual period. It may get better during your period. But if an implant grows in a sensitive area such as the rectum, it can cause constant pain or pain during sex, exercise, or bowel movements.
Symptoms often get better during pregnancy and after childbirth and usually go away after menopause.
In That Sense There Is No Cure For Endometriosis But The Symptoms Canbe Reduced With The Right Treatment Communication Is The Key To Finding A Treatment That Fits You
There are several management options for women with endometriosis, surgical excision of the lesions is the only treatment to remove the disease. In a small percentage of women, endometriosis lesions may recur after excision, the true incidence is unknown.
The best treatment depends on your decisions surrounding fertility and quality of life, it also depends on access to an experienced surgeon.
Many women are offered medical treatments, especially when they are awaiting a diagnosis, surgery or further treatment. These include pain medications, hormonal medications and other drugs used for chronic pain. Medical treatments do not treat endometriosis lesions and can not remove endometriosis. Medical treatments treat symptoms whilst on the treatment, symptoms often recur once the treatment is stopped.
These factors include:
The preferences of the woman
The type of disease
The severity and type of pain symptoms
The wish to become pregnant immediately or at a later stage
The costs and side effects of some treatments
The age of the woman
The treatments she has already received
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Consequences For The Future
Women operated for endometriosis/adenomyosis and further desire to have children, a continuous treatment with progestogens should be done until conception is desired.
Treatments For Infertility Related To Endometriosis
In most cases, healthcare providers will recommend laparoscopy to remove or vaporize the growths to also improve fertility in women who have mild or minimal endometriosis.8 Although studies show improved pregnancy rates following this type of surgery, the success rate is not clear.
If pregnancy does not occur after laparoscopic treatment, in vitro fertilization may be the best option to improve fertility. Taking any other hormonal therapy usually used for endometriosis-associated pain will suppress ovulation and delay pregnancy. Performing another laparoscopy is not the preferred approach to improving fertility unless pain symptoms prevent undergoing IVF. Multiple surgeries, especially those that remove cysts from the ovaries, may reduce ovarian function and hamper the success of IVF.8
IVF makes it possible to combine sperm and eggs in a laboratory to make an embryo. The resulting embryos are placed into the womans uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis.
Even though the use of hormones in IVF is successful in treating infertility related to endometriosis, other forms of hormone therapy are not as successful. For instance, ACOG does not recommend using oral contraceptive pills or GnRH agonists to treat endometriosis-related infertility. Using these hormonal agents prevents ovulation and delays pregnancy.1,11
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Hormone Balancing: Getting To The Root Of Endometriosis
We know that lifestyle strategies which decrease inflammation, improve the immune system, support the liver and hormonal balance can go a long way in treating endometriosis. In addition to exercising regularly and getting plenty of sleep, a large portion of these lifestyle changes are linked to diet. To ensure that we are giving our bodies a fighting chance at treating endometriosis, we should be consuming a diet that ticks the following boxes:
- Improves immune function foods containing phytonutrients such as leafy green vegetables berries and seeds such as flaxseed.
- Supports general detoxification fibrous foods such as beans wholegrains for B vitamins leafy green vegetables other nutrient-rich vegetables such as artichokes, beetroot and carrots healthy, clean proteins such as those found in salmon .
- Supports estrogen detoxification sulforaphane-containing vegetables and cruciferous vegetables such as broccoli, sprouts, cabbage, kale, cauliflower.
Supplements That Can Help Alleviate Endometriosis:
- Processed carbohydrates
- Processed foods containing preservatives
What Happens When A Woman Has Endometriosis
Endometriosis is a condition in which tissue that normally lines the inside of the uterus grows outside of it. This extra tissue can attach to the ovaries, fallopian tubes, and other parts of the pelvis. Endometriosis can cause pain, heavy bleeding, and other problems. The most common symptom of endometriosis is pelvic pain. Other symptoms include pain with sex, pain with urination or bowel movements, fatigue, and infertility. Endometriosis can be diagnosed with a pelvic exam, ultrasound, or MRI. Treatment options include medication and surgery. Some women with endometriosis may need to take medications to relieve pain or prevent the condition from getting worse. Surgery to remove the endometriosis tissue may also be recommended.
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What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to use hormone therapy
Reasons not to use hormone therapy
I want to control my pain better.
I get enough pain relief from anti-inflammatory medicines.
I don’t want to wait until menopause for my pain to go away.
I want to wait as long as I can before I start using hormones.
I can handle the side effects of hormones for a few months.
I don’t want to deal with the side effects of hormones even for a few months.
I want to have a baby, but I’m willing to put off trying to get pregnant for 6 months or a year.
I want to get pregnant in the next year.
Chinese Herbs Stand Toe
Herbal formulas are often used in traditional Chinese medicine to treat uterine health issues like endometriosis.
TCM cites blood stasis as the cause for this health problem. Lesions form when blood slows or pools in the abdomen and other sites within the body.
A review of studies published in the Cochrane Database of Systematic Reviews found that Chinese herbs used to treat blood stasis fared well when compared to the steroid gestrinone in curbing endometriosis pain after laparoscopic surgery.
Oral and enema forms of these herbs also eased pain just as well as the steroid drug danazol when used outside of surgery.
Despite these findings, the authors point to the need for more rigorous research to assess how well Chinese herbs treat and lower the risk for this condition.
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Endometriosis Welling Expert View
Endometriosis is a common but often misunderstood condition. If you are one of the millions of women who suffer from endometriosis, know that you are not alone. There are many treatment options available to help lessen your symptoms and improve your quality of life. While there is no cure for endometriosis, with the right management plan, you can still lead a happy and productive life. We hope this article has helped you learn more about this condition and given you some tools to manage it.
Combination Oral Contraceptive Pills
COCPs act by ovarian suppression and continuous progestin administration. Initially, a trial of continuous or cyclic COCPs should be administered for 3 months. With pain relief, this treatment is continued for 6-12 months. Pregnancy rates following discontinuation of the pill are 40-50%. This applies to a population unselected for stage and fertility status of the disease. Although few choices are available among individual formulations, note that the long-term efficacy of multiphasic preparations remains unproven.
Continuous noncyclical administration of COCPs, omitting the placebo menstrual tablets, for 3-4 months helps avoid any menstruation and associated pain. A study by Guzick et al examined a head-head-to-head comparison of Lupron and continuous oral contraceptives for the treatment of endometriotic pelvic pain both were found to be equally effective.
Women with endometriosis are at increased risk of epithelial ovarian cancer, and COCPs are believed to protect against this.
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Inducing The Menopause What Are The Risks
The risks of artificially and prematurely inducing the menopause include osteoporosis, along with the side effects of the menopause resulting from low oestrogen levels that include hot flushes, night sweats, skin dryness and insomnia.
Osteoporosis is the thinning of the bone density that increases a womans riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as the chance of falling were one in four . This measure is good no matter the incidence of events i.e. common or infrequent. of fractures. Our bone strength and density is reliant on calcium that is constantly in balance between blood calcium forming bone and calcium released from bone to maintain blood levels. Oestrogen reduces the amount of calcium released from the bone, and this prevents thinning and reduces the risk of osteoporosis and fractures.
The risks associated with HT are blood and cancer related. A recently published Cochrane systematic review found very interesting and divided answers depending on the age of the groups analysed. When examining the results of all women that take HT there is evidence of increased risk of suffering blood clots in the legs or the lungs or having a stroke. But for women taking it close to their menopause or younger than 60 the risks and benefits look different. For further information on this new evidence on HT in women please read Harry Boardmans blog.
What Is Natural Treatment Of Endometriosis
Endometriosis is a medical condition in which the tissue that normally lines the inside of the uterus grows outside of the uterus. This can cause pain, heavy bleeding, and fertility problems. The exact cause of endometriosis is unknown, but it is thought to be caused by a combination of hormonal and genetic factors. Women who have certain risk factors, such as a family history of endometriosis or early onset puberty, are more likely to develop the condition. Treatment for endometriosis typically involves medication to relieve pain and improve fertility. Surgery may also be necessary to remove areas of abnormal tissue growth.
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