Endometriosis is treated with medications, but are you taking the right one?
Women with endometriosis classically present during their reproductive years with pelvic pain, painful menstrual periods, and painful sex. Some women may be diagnosed with endometriosis after being evaluated for infertility or an ovarian mass (endometrioma), independent of pain. Painful menstrual periods are typically described as dull or crampy pelvic pain that typically begins one to two days before a woman’s period. Pain usually persists throughout the menstrual period and can continue for several days afterward.
Once a diagnosis is established, low-dose continuous birth control pills are commonly prescribed as a first-line hormonal treatment for pain caused by endometriosis. This simple treatment is highly effective when initially prescribed. Some women, however, may experience a recurrence of pain. If this occurs, another treatment approach is needed.
Progestin-only medications are hugely useful in the treatment of pain caused by endometriosis. High-dose progestin-only medications suppress the hormones secreted in the brain [luteinizing hormone (LH) and follicle-stimulating hormone (FSH)] which in turn suppresses ovarian synthesis of estrogen. This, in turn, results in low circulating levels of estrogen and removes the stimulus that exacerbates endometriosis disease activity. High-dose progestins also directly suppress cellular activity in endometriosis implants. This type of medical therapy can be administered orally in pill form, by injection, and as an intrauterine device (IUD).
Gonadotropin analogues reduce pelvic pain caused by endometriosis by suppressing the brains secretion of LH and FSH, again reducing ovarian synthesis of estrogen. In the past, these medications were only available in injection form, but recently an oral pill form has come on the market.
Newer research is investigating medications frequently used in breast cancer survivors that block estrogen in a unique way, however, more data is needed before this treatment will be available in clinical practice.
Pelvic pain from endometriosis can be a struggle during a woman’s life, but there are many medications available if her current regimen is not working. Most women will find relief if they are evaluated and begin a new treatment from a different class of medication. Millions of women in our country have pelvic pain caused by endometriosis and by using every available hormonal agent, we will improve the treatment of pelvic pain caused by endometriosis. We are here to help you feel your best, please contact the Couri Center for evaluation of any concern you may have.
Kaleb Jacobs, D.O.