The next step up is to treat the source of the pain, specifically the estrogen release that inflames endometriosis. “[Hormonal] strategies for treating endometriosis suppress menstrual cycle events by shutting off communication between the brain and ovaries or preventing the uterine lining from thickening,” Stratton says. When cells of the lining proliferate, so too can the endometriosis cells outside the uterus.
Disrupting the hormonal triggers is often accomplished with the use of combination birth control pills or the NuvaRing, which both contain estrogen (at low enough levels not to stimulate the endometriosis) and progestin, a synthetic form of progesterone. There are also progestin-only methods, like the Mirena IUD. But experts emphasize that these don’t work for everyone, and since endometriosis is a progressive condition, more drastic treatment can be necessary.
In those instances, some doctors will recommend Lupron, known as a GnRH (gonadotropin-releasing hormone) agonist, but that’s a divisive topic. GnRH is involved in estrogen production, and GnRH agonists cause an initial flare of estrogen but then drastically lower the levels of the hormone, bringing about menopause and potentially reducing endometriosis symptoms.
There’s a host of worries about Lupron. Women may experience hot flashes, sleep disturbances, and mood problems when on the drug, Stratton says. In rare cases, Lupron can cause issues like joint pain and memory loss, Sinervo says. “We also don’t know what the long-term side effects are of the medication,” he adds.
The body’s resulting lack of estrogen adversely impacts bone density (interestingly enough, the progestin in progestin-only BC metabolizes into a form of estrogen that is very weak but still beneficial for bone health, Stratton says). It’s also only recommended for six months maximum, after which symptoms can return.
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Lupron’s manufacturer recently arranged for the possibility of prescribing it paired with norethindrone, or a type of progestin that helps temper the bone loss, but it’s taking a while to catch on, Stratton says. In the meantime, studies on a class of drugs known as GnRH antagonists, which immediately lower estrogen without that initial surge that can worsen symptoms, are ongoing, but they don’t seem promising, Sinervo says.
The rub: Treatments can be variably effective for different women, bringing relief for many and failing others, but one thing that’s true for all endometriosis sufferers is that once you stop taking them, the disease usually flares back up.
Long seen as the closest thing to a cure, invasive surgery is not the answer for all endometriosis sufferers, and some doctors are looking for more targeted treatments.
Even a surgery that removes the uterus and ovaries (whence estrogen is secreted) doesn’t necessarily put an end to the misery. It’s true that in some cases, having a hysterectomy and removing the ovaries may help mitigate the symptoms. But it’s far from a be all, end all treatment. For one thing, having a radical hysterectomy means a woman won’t be able to conceive or carry children, if that’s something she wants to do, so it’s a deeply complicated, personal, and emotional decision. Moreover, you can take away the “sources” of the problem but still be left with endometriosis lesions on other organs that may produce their own estrogen and continue to be painful and problematic, along with other artifacts of the disease.
Source: SELF
