Drugs Commonly Used to Treat Endometriosis
Drug : Combination estrogen-progestin oral contraceptives
Side Effects:
Abdominal swelling, breast tenderness, increased appetite, ankle swelling, nausea, bleeding between periods, deep vein thrombosis
Drug: Progestins
Side Effects:
Bleeding between periods, mood swings, depression, atrophic vaginitis
Drug: Danazol
Side Effects:
Weight gain, acne, lowered voice, hair growth, hot flashes, vaginal dryness, ankle swelling, muscle cramps, bleeding between periods, decreased breast size, mood swings, liver malfunction, carpal tunnel syndrome, adverse effects on lipids
Drug: GnRH agonists
Side Effects: Hot flashes, vaginal dryness, calcium loss from bone, mood swings
Treatment depends on a woman's symptoms, pregnancy plans, and age, as well as the extent of the disease.
Drugs that suppress the activity of the ovaries and slow the growth of the endometrial tissue include combination oral contraceptives, progestins, danazol, and GnRH (gonadotropin-releasing hormone) agonists.
GnRH agonists are substances that first stimulate the release of gonadotropins from the pituitary gland but later suppress gonadotropin release when administered for more than a few weeks.
Whether treating women who have minimal or mild endometriosis improves pregnancy rates isn't clear; however, treating women who have more severe disease with drugs or surgery results in pregnancy rates ranging from 40 to 60 percent. Drug treatment doesn't cure endometriosis; the disease usually returns after treatment is stopped.
Can Surgery Help You ?
If a woman has moderate to severe endometriosis, surgery may be necessary. A doctor removes as much misplaced endometrial tissue as possible, generally while preserving the woman's ability to have children.
Often, the tissue is removed during laparoscopy when the diagnosis is made. Surgery is usually necessary for patches of endometrial tissue larger than 1½ to 2 inches in diameter, for significant adhesions in the lower abdomen or pelvis, and for endometrial tissue that obstructs one or both fallopian tubes or that's causing extreme lower abdominal or pelvic pain unrelieved by drugs.
Sometimes electrocautery (a device that uses an electrical current to produce heat) or a laser (a device that concentrates light into an intense beam to produce heat) is used to remove endometrial tissue. However, surgical removal is only a temporary measure; endometriosis recurs in most women.
Pregnancy After Endometrial Surgery : Your Odds
After endometrial tissue has been removed, pregnancy rates range from 40 to 70 percent, depending on the severity of the disease; drug treatment may improve these rates.
Oral contraceptives may slow disease progression after drug treatment or surgical removal of endometrial tissue. However, only surgical removal of both ovaries prevents endometriosis from recurring.
The ovaries and uterus are removed only in women who have lower abdominal or pelvic pain unrelieved by drugs and who aren't planning to become pregnant.
After the ovaries and uterus are removed, estrogen replacement therapy is started, because this surgery has the same effects as menopause.
This therapy is started either immediately after surgery or, if a lot of endometrial tissue remains, after a delay of 4 to 6 months. The delay allows the endometrial tissue, which would be stimulated by estrogen replacement therapy, to disappear. During the delay, drugs to suppress endometriosis may be need
From The Merck Manual
