Endometriosis Painful, but Treatable : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 2)

Endometriosis sometimes causes premenstrual staining and, as the period progresses, heavy menstrual flow.

Often, endometriosis remains hidden a long time. A symptom such as pain at menstruation may not be seen as unusual, explains Mary Lou Ballweg, executive director of the Endometriosis Association.

"Perhaps a young woman is told by Mom, who had the same problems, that menstrual pain is normal," Ballweg says. "So she just lives with it and doesn't see a doctor until the symptoms become unbearable. Some young women with endometriosis have apparently normal menstrual periods for years before having discomfort and pain. Others report they've nearly always had difficult periods."

As many as 30 percent of women who report infertility problems have endometriosis.

Severe endometriosis can lead to infertility in various ways. In the ovaries, it can produce cysts that prevent the egg's release. In the fallopian tubes, implants can block the passage of the egg. Also, adhesions can fix ovaries and tubes in place so that projections on the tubes can't grasp the egg and move it into the tube. The effect of mild endometriosis on infertility is less clear.

Women with endometriosis may have a higher rate of "ectopic" pregnancy, a potentially life-threatening condition in which the fertilized egg begins to develop outside the womb.

The most common way to see whether a woman has endometriosis is by surgical examination using laparoscopy, a fairly simple procedure usually done without an overnight hospital stay. The doctor makes a tiny incision and inserts a lighted, flexible, telescope-like device called a laparoscope that allows a close look at the pelvis and internal organs. However, sometimes the implants themselves can only be seen through microscopic evaluation of biopsy specimens.

Drug Treatment

Drugs for endometriosis should not be taken by women who are, or who may be, pregnant.

The earliest drug approved to treat endometriosis was Danocrine (danazol), a synthetic steroid related to the hormone testosterone. Taken orally, in pill form, Danocrine changes endometrial tissue, shrinking and eliminating implants in some cases. Side effects include fluid retention, weight gain, and masculinizing effects such as voice change, hairiness, and reduction of breast size. Other side effects include menstrual irregularities, hot flashes, and vaginal dryness.

Other drugs, related to gonadotropin-releasing hormone (GnRH), act in a different way to decrease the hormones that make abnormal implants grow. One version is a nasal spray called Synarel (nafarelin acetate). In clinical studies, Synarel, at 400 or 800 micrograms a day (within the prescribed dosage range), was comparable to Danocrine at 800 milligrams a day (the recommended dosage) in relieving the clinical symptoms of endometriosis (such as pain) and in reducing the size of implants. Side effects include non-menstrual vaginal bleeding or ovarian cysts during the first two months of use, cessation of menstruation, hot flashes, headaches, decreased sex drive, vaginal dryness, acne, reduction in breast size, and a small loss in bone density. In clinical trials, about 10 percent of the patients experience nasal irritation from the spray.

Other drugs approved for treatment of endometriosis that are chemically related to Synarel include Lupron Depot (leuprolide acetate), a drug injected monthly into muscle, and Zoladex (goserelin acetate implant), which is injected under the skin of the upper abdomen. These drugs don't cause nasal irritation, but otherwise their side effects are similar to those of Synarel, and their effectiveness is also similar.

Women taking endometriosis drugs need to watch for problems such as difficulty breathing or chest or leg pain, which may indicate a blood clot and should be reported to the doctor immediately. Other possible severe side effects include irregular heart rhythms. Frequent checkups are needed to monitor effects such as possible thinning of the bones. A patient should immediately report any new or worsened symptoms to the doctor. However, it's normal for endometriosis symptoms to temporarily worsen when a woman begins taking medicine.

Surgery

Sometimes medicine is not enough. Surgery may be needed to remove diseased tissue or to correct misaligned organs.

One method to remove diseased tissue combines laparoscopy with laser surgery. The laser is connected to the laparoscope and positioned so that its intense light beam is directed through the laparoscope onto the tissue to destroy it. The procedure usually is done without an overnight hospital stay and requires only about a week's recovery time at home.

Recurrence rates after treatment need further study, Ballweg says.

The monthly pain and heavy menstrual periods of chronic endometriosis can be frustrating and painful, and can lead to conceiving and infertility problems. But today, with prompt diagnosis and treatment, a young woman's life can often return to normal.

About the Author

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