Endometriosis: More Treatment Options than Ever
What is Endometriosis?
Endometriosis can’t be cured, but the pain and fertility problems it causes can be relieved. Of the more than 5.5 million American women with endometriosis, 30 to 40 percent have difficulty conceiving.
In endometriosis, small islands of tissue similar to the inner lining of the uterus (endometrium) implant themselves on other organs or on the lining of the pelvic cavity. During menstruation, they bleed and cause painful inflammation.
The results can be severe menstrual cramps, heavy periods, painful sex and difficult bowel movements.
While endometriosis cannot be cured, there are many ways to treat it, says Jean Uy-Kroh, MD, of Cleveland Clinic’s Center for Specialized Women’s Health.
Hormonal Contraceptives: Fewer periods, less pain
Doctors commonly prescribe hormonal contraceptive agents to control endometriosis. They help to shrink excess endometrial tissue, reduce menstrual cramps and prevent the condition from worsening.
“Hormonal agents that reduce the frequency of periods are popular choices,” says Dr. Uy-Kroh. “The pills may contain progesterone and estrogen or just progesterone alone.”
These pills are taken daily to suppress the ovaries from ovulating and to prevent periods. Placebo pills — or a break from medication — are sometimes taken for one week to allow periods to occur.
Some women may experience just four periods a year or even less, depending on how the medication is prescribed.
IUDs: Out of sight, out of mind
Another option for treating endometriosis is the Mirena® intrauterine system, or IUS. The T-shaped device can remain in the uterus for five years, releasing low levels of a synthetic form of progesterone.
The Mirena IUS prevents the growth of endometrial tissue and reduces menstrual flow by up to 90 percent, explains Dr. Uy-Kroh.
Hormones: Taking a shot at symptoms
Another option to consider are Depo Provera® birth control injections. These shots, administered in the doctor’s office every three months, contain a potent form of progesterone. Depo Provera can produce shorter, lighter periods.
If birth control pills or Depo Provera don’t help, doctors may try monthly leuprolide injections. Leuprolide is an even stronger synthetic hormone that suppresses the growth of endometrial tissue.
Medical treatment relieves pain but does not improve fertility, cautions Dr. Uy-Kroh. So women with endometriosis who hope to have children should let their physician know sooner rather than later.
Laparoscopy: Scoping out the problem
An outpatient procedure can confirm that endometriosis is present. An Ob/Gyn specialist inserts a slim viewing tube (laparoscope) through a tiny belly-button incision. The outside of the uterus, ovaries, fallopian tubes and other pelvic organs are examined. Small tissue samples are removed for biopsy.
Surgery: A necessary step for some
If the biopsies show that endometriosis is present, surgery may be necessary to relieve symptoms or improve fertility. At the time of laparoscopy, instruments can be inserted through a second small incision in the belly to remove or destroy endometrial implants.
For widespread endometriosis, traditional abdominal surgery may be needed.
“Surgery is often successful in relieving pain, especially when oral contraceptives are used afterward,” says Dr. Uy-Kroh. “However, up to 20 percent of women will need additional pain management.”
Women who have completed their families may wish to have hysterectomy (surgical removal of the uterus), with or without removal of the ovaries. This relieves painful endometriosis. However, it should be considered carefully as a last resort, cautions Dr. Uy-Kroh.
Surgery to remove endometriosis implants may not be the solution for patients with fertility issues. Endometriosis recurs in 20 to 40 percent of all patients within five years of surgery.
Fortunately, there are other options.
In vitro fertilization
In vitro fertilization (IVF) is one option for women with endometriosis. It is a highly successful alternative, says Cynthia Austin, MD, Medical Director of Cleveland Clinic’s In Vitro Fertilization Program.
IVF begins with hormone treatments, which stimulate the ovaries to produce multiple mature eggs. When ready, the mature eggs are collected through outpatient guided-needle biopsy, done under sedation.
The eggs may be exposed to sperm in a culture dish in the laboratory. Or a single sperm may be injected into each mature egg.
Once the eggs are fertilized, embryo development is closely monitored. Selected embryos are placed into the woman’s uterus and additional ones are frozen.
Today, IVF results in very high pregnancy rates with the transfer of far fewer embryos, says Dr. Austin. This makes pregnancies much safer.
Other options for future pregnancy
For women with endometriosis who are unmarried or otherwise not ready to conceive, new technology allows eggs to be retrieved and frozen for future use, she adds.
For more information on endometriosis, download our free Endometriosis Treatment Guide.
Cleveland Clinic Center for Specialized Women’s Health and Fertility Center specialists are available to see patients with endometriosis at our main campus and at family health centers across Northeast Ohio. For appointments, call 216.444.4HER. Visit us online at clevelandclinic.org/womenshealth.