Women and adolescents with endometriosis have a significantly impaired quality of life and reproductive function. In addition, the disease can cause infertility in some cases. Laparoscopic excision is the best treatment for the disease but there are other approaches that can help manage the disease.
The goal of laparoscopic intervention is to diagnose and excise all visible and palpable diseases. Laparoscopic excision, when performed by a capable surgeon, thoroughly removes all forms of the disease. It also restores normal organ placement and function and treats pelvic pain and infertility. Laparoscopic excision can lead to substantial symptomatic relief and resolution of infertility in most cases.
Other surgical approaches include ablation, cauterization, fulguration, or vaporization through the laparoscope. These methods involve only superficial removal of topical lesions in the pelvic region. Such incomplete removal may offer temporary relief. However, studies have placed recurrence rates at 40-60% within the very first year following this type of surgery.
However, you may not be ready for surgery and may want to manage the disease nonsurgically. If so, we’ve included alternative methods to managing your endometriosis. We want to stress, however, that these options are not treatments.
Medical suppression to manage the disease
Studies have shown that misplaced endometrial tissue responds to hormones and goes through a menstruation-like process in reaction. To that end, estrogen is like fuel for the fire in the disease process of endometriosis. Popular medical treatments largely aim to stop estrogen secretions, primarily in the ovaries to suppress menstruation and maintain a temporary phase that mimics menopause. Suppression therapies include GnRH-A, aromatase inhibitors, progestin therapy, the Mirena® coil, and continuous oral contraceptives
Lupron®, Zoladex®, Synarel®, and Suprefact® are common GnRH-A drugs. They aim to initially stimulate the ovaries to produce more estradiol (the most potent form of estrogen). In the second phase, after anywhere from approximately seven to 21 days of constant stimulation, the drugs shut down the “messenger” hormones that the pituitary gland sends to the ovaries. The result is that the ovaries shut down, estradiol levels drop sharply and rapidly, and the patient ceases to ovulate or menstruate – a condition similar to menopause.
GnRH-As are far from curative; they aim only to manage the symptoms of endometriosis temporarily. Indeed, rates of recurrence in the first year following therapy are as high as 74.4%. GnRH-As may also have significantly negative – and long-lasting – side effects ranging from bone density loss to impaired memory, among others.
Endometriosis implants make their own estrogen through the abnormal expression of the aromatase enzyme, thus creating a self-sustaining life cycle. Similar to GnRH-A therapy, aromatase inhibitors such as Letrozole® are a relatively new class of drugs that also temporarily suppress estrogen levels. They target not only estrogen production in the ovaries (as with GnRH-A), but also in adipose (fat) tissue and perhaps most importantly, within the endometriosis implants themselves. Again, the measure is temporary and is intended for short-term symptomatic relief only. Side effects are expected to be similar to those of Lupron and other GnRH-A drugs. Recurrence in the long-term has not been adequately studied.
Commonly achieved through the use of Depo Provera®, this therapy artificially creates levels of the hormone progesterone, which resemble the amounts in the body during pregnancy. This, in effect, stops the monthly growth of the uterine lining and reduces estrogen production. In turn, this stops ovulation and menstrual periods in most women. As with the aforementioned therapies, the absence of a period may lead to temporary symptomatic relief in some women or girls. Some others may find potential side effects to be intolerable. The disease usually recurs when women stop the therapy.
The Mirena® coil
The Mirena coil is another progestin therapy. This small, plastic T-shaped intrauterine device (IUD) contains a synthetic progesterone-like substance that is released into the uterus over a five-year period. Little information is available on the use of Mirena for women with endometriosis and its use is largely anecdotal. The Mirena® IUD is a relatively new option for women and girls with the disease. So, only limited studies as to its effectiveness, potential side effects, and long-term outcomes exist.
Continuous oral contraceptives
Continuous administration of an oral contraceptive (OC) may be an option in women and girls with the disease who continue to experience recurrent dysmenorrhea despite cyclic (“normal”) OC use. Such administration works, as with all hormone therapy, by suppressing menstruation and theoretically inhibiting disease growth. Studies have reported moderate to severe side effects ranging from weight gain to depression.
Painkillers to manage the pain
Analgesics ranging from over-the-counter NSAIDs such as aspirin or ibuprofen to prescribed narcotics such as Vicodin® or Percocet® may help reduce some of the symptoms associated with the endometriosis. However, they do not remove or treat the disease.
Diet and nutrition to manage symptoms
Many patients are able to effectively reduce and even control their symptoms through a dietary approach. Many women and adolescents with endometriosis suffer from certain food allergies or intolerances (e.g., gluten, lactose). This dietary approach could improve these.
A dietary regimen that inhibits prostaglandin production (hormones that contribute to symptoms and cause pain) and promotes anti-inflammatory, healing properties can restore certain deficiencies. It can also lead to hormonal balance, and ostensibly reduce symptoms of endometriosis.
The dietary approach can also address the candida (yeast) infections that many women with endometriosis experience.
No single diet will work for all women and girls with the disease. However, it is a non-invasive means of improving overall health.
Alternative therapies to manage the disease
Some women may adopt “alternative” approaches to alleviating their symptoms. This may include any healing method from the use of herbs to varied pain management techniques. Some of the most popular methods that the endometriosis community uses are below.
Herbal medicines can be prepared from the roots, flowers, stems, leaves, or bark of plants. They can be inhaled, applied as a topical salve, inserted as a suppository, or ingested orally in a tablet form or a tea. Different herbs may be combined to increase effects. One idea is that treating a presumed weakness in the liver may have a relieving effect.
Dandelion, Beet leaves, Cascara, Uva Ursi, Blue, and Black Cohosh, Cranberry, Plantain, St. John’s Wort, Peppermint, Valerian, Dong Quai, False Unicorn, Evening Primrose Oil, Chasteberry/Vitex, Couchgrass, Red Raspberry, Yam, and White Willow have all been reported to be helpful in relieving symptoms.
It is extremely important to remember that though herbs are natural, they can be extremely toxic. Before considering herbal therapy you should seek advice from your healthcare provider.
According to the philosophy, good health results in a balance and free flow of Ch’i through “the meridians”, while illness is an imbalance, stagnation, or obstruction of Ch’i in a meridian. Placing thin needles in the various points linked by these meridians is believed to restore the balance and flow of Ch’i. Acupuncture is not available nationwide. Check with your state medical association for the laws surrounding acupuncture and a possible referral.
Transcutaneous electrical nerve stimulation (TENS)
This is a technique to control pain in which a small machine conducts an electric current through electrodes placed on the painful areas. When it is successful, pain relief is often very quick. Patients may also purchase portable units for use whenever the pain strikes. See your healthcare provider for more information.
A Japanese finger-pressure technique similar to massage, Shiatsu stimulates Ki (the same as Chinese Ch’i) to balance free flow and eliminate pain. The therapist may also prescribe home exercises to do along with the Shiatsu treatments. Check with reputable alternative healthcare providers in your region for more information.
Exercise is a demonstrated stress reliever, pain reducer, and depression fighter. It also provides obvious benefits such as weight control and improved cardiovascular health. For example, swimming and walking are two low-impact, easy-to-do exercises. Seek the assistance of a trained professional who is familiar with your condition and work out a regimen that suits your needs and abilities best.
Biofeedback involves the altering of body processes such as heart rate, muscle activity, skin temperature, and brain wave activity. It is done through the use of electrodes attached to the skin, which convert minute physiological, chemical, or electrical changes into auditory or visual signals. Biofeedback is most effective if combined with other relaxation techniques. Ask your doctor for more information.
Homeopaths stimulate and bolster healing mechanisms within the body through minute doses of natural remedies that would in otherwise healthy persons, actually produce the symptoms of endometriosis. The credo “like cures like” is the driving theory behind this approach. Consult a licensed homeopathic professional to learn more.
Osteopaths believe that correcting structural problems through the manipulation of muscles, ligaments, and bones can treat disease. Chiropractors, on the other hand, believe correcting dislocations (subluxations) in the musculoskeletal system alone can treat disease.
“Nature cures” is the belief behind this approach. It is a practice-based solely on natural methods of healing. These include, often in combination, fasting, vitamin and mineral therapy, color therapy, colonics, hydrotherapy, herbs, breathing exercises, physical exercise, massage, joint manipulation, and acupuncture, among other techniques or applications. Some licensed naturopath physicians are also able to perform minor surgery. Check with your local healthcare providers for more information.
Get a Second OpinionOur endometriosis specialists are dedicated to providing patients with expert care. Whether you have been diagnosed or are looking to find a doctor, they are ready to help.
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Dr. Seckin is an endometriosis specialist and women’s reproductive health advocate. He has been in private practice for over 30 years at Lenox Hill Hospital with a team of highly skilled personnel.
Dr. Seckin specializes in advanced laparoscopic procedures and is recognized for his expertise in complex cases of deep infiltrating endometriosis of the pelvis. He is particularly dedicated to performing fertility-preserving surgeries on cases involving the ovaries.
He has developed patented surgical techniques, most notably the “Aqua Blue Excision” technique for a better visualization of endometriosis lesions. His surgical techniques are based on precision and microsurgery, emphasizing organ and fertility preservation, and adhesion and pain prevention.
Dr. Seckin is considered a pioneer and advocate in the field of endometriosis.