What are the treatment options
Medical ( non-surgical) Management
The type of medical management depends on the severity of her pain symptom and whether she is trying to conceive.
If she is not planning for a pregnancy, pain killer medication from the group known as non-steroidal anti-inflammatory (NSAIDs) can control her pain symptom.
Usually the pain killers are given in combination with hormonal treatment such as a combined contraceptive pill (birth control pill which has both the oestrogen and progesterone components).
Image Source: Reader’s Digest
If the woman can not tolerate side effects of oestrogen , progesterone -only hormonal medications can also be used. These form of medications can be administered orally, in the form of 3-monthly injections, progesterone implant or as a intrauterine device.
In women who has severe symptoms and who are not concern with infertility , monthly or 3-monthly injection to temporarily “stop” her ovarian activity can be given. These injections are known as gonadotrophin releasing hormone analogue (GnRh analogue). These injections are commonly used with oral hormonal supplements to prevent bone loss. It is effective to alleviate pain symptom but the symptoms tend to recur once treatment is stopped.
The other type of “ovarian blocker” is known as GnRh antagonist. It can be given orally or as an injectable.
Image Source: Live Strong
For women who desire a pregnancy, unfortunately many of the hormonal or ‘ovarian blockers’ are not appropriate as they will prevent ovulation. Oral NSAIDs can be given for pain symptoms.
These woman should seek early advise from a fertility specialist. Many of them may need some form of assisted reproductive treatments to get them pregnant.
Laparoscopy (keyhole surgery) is needed in most cases of endometriosis either as a diagnostic or a therapeutic tool.
For women with ovarian endometrioma (ovarian cyst resulting form endometriosis) or with deposits of endometriosis outside the uterus, laparascopy can be used to remove the cyst and destroy the endometriotic spots. These intervention may help to reduce pain symptom and is suitable for women who desire a pregnancy.
Image Source: IVF Surrogacy
A more definitive surgical procedure is to remove a woman’s womb (uterus) with or without removal of her ovaries. This can be done via a laparoscopy or a conventional open surgery.
This is usually offered for a more severe pain symptom and for a woman who has completed her family.
Laparoscopic nerve ablation (destroying the nerve ends) has also been offered to reduce pelvic pain. However, their efficacy has not been established.
Acupuncture and diet modifications has been advocated as a possible therapy for endometriosis. Research has suggested possible therapeutic effect of acupuncture for period pain.
Image Source: Politeka
Research also suggest some correlation between diet and period pain but so far there is no effective dietary recommendation for prevention or treatment of endometriosis.
Many women may suffer from a ‘silent pain’ due to undiagnosed endometriosis. Women who suffers from period pain or have difficulty getting pregnant should consult a specialist doctor and seek appropriate advise early, especially if they have endometriosis as no women should suffer in silence.
Dr. Agilan Arjunan
Obstetrician & Gynaecologist (infertility)