Evidence-Based Management
There is no known cure for endometriosis. Available treatments, however, can relieve symptoms and improve quality of life by addressing severe pain through various modalities.
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Hormonal treatments: suppress estrogen production in the body, and in turn suppress the menstrual cycle. Hormonal treatments are usually taken for 3-6 months, and can be taken on a longer if needed.
- Combined oral contraceptives (COCs): Estrogen-Progestin play major roles in the menstrual cycle and mimic a “pregnancy-like” state.
- GnRH (gonadotropin-releasing hormone) antagonists: suppress the menstrual cycle by down-regulating hypothalamic-pituitary GnRH receptors, resulting in decreased gonadotropin secretion and reduced serum estrogen levels (Divasta & Laufer, 2013).
- SE: short-term symptoms similar to menopausal symptoms (e.g. vaginal dryness); long-term effects include reduction in bone mineral density
- Add back therapy: GnRH antagonists treatments cause bone loss, so progestine or biphosphohonates are usually prescribed as an adjunct to GnRH treatments (Divasta & Laufer, 2013).
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Surgical treatments
- Laparoscopy: diagnosis and lesion removal can happen simultaneously. While effective, recurrent lesions can occur within a few years (Alkatout at el, 2013).
- Hysterectomy: removal of the uterus, reserved for when other treatment options have been unsuccessful.
Best Practice-combined surgical and hormonal therapy
Treatment efficacy may increase when medical and surgical treaments are used together (McCance & Huather, p. 825, 2014). Also, study by the Journal of Minimally Invasive Gynecoloy supports best treatment for the management of endometriosis is combined medical and surgical therapy (Alkatout, et al., 2013).
Non-hormonal treatments: prospects for future development (rodent study)
Omega 3 fatty acids inhibit release of inflammatory mediators and prostaglandins in endometrial stromal cells. N-acetylcysteine is an antioxidant, which decreases inflammatory protein activity that causes inflammation and decrease in gene activity (Platteeuw & D”Hooghe, 2014).
Metformin is widely used hypoglycemic agent but interestingly, it was found that in rodents it suppresses inflammatory cells, proliferation of stromal cells, and angiogenesis. One study found that rats with induced endometriosis that was given 100 mg/kg/day during 4 weeks showed reduced surface of endometrial lesions and severity of adhesions when compared with placebo (Platteeuw & D”Hooghe, 2014).
Ongoing support: Women who suffer from endometriosis endure chronic pain, fatigue, and infertility, which greatly affect their physical and mental well-being (World Endometriosis Research foundation, 2015). Helping women make an informed decisions and weighting the benefits and risks involved in treatment selections is very crucial. As healthcare providers, we are the advocates of our patients and need to provide holistic care by looking at the physical and mental well-being of our patients.