Endometriosis Treatment to Enhance Fertility
Approximately one in ten women of reproductive age suffer from endometriosis, a condition in which the uterine lining (endometrium) grows outside the uterus. Endometriosis is a very common cause of female infertility.
Normally, the uterus sheds the endometrial lining during menstruation, but when this tissue grows elsewhere, the body cannot properly shed it. Endometrial tissue sometimes grows in the walls of the fallopian tubes or near the fimbriae which pick up the egg once it is ovulated. This can cause scarring or adhesions and create a blockage that prevents eggs from entering the uterus for normal fertilization. Although no known cure exists for endometriosis, numerous medications and surgical procedures can help patients control the symptoms and correct the infertility.
Surgical Treatment for Endometriosis
Endometriosis is quite common in the infertility patients. Unfortunately, the only way to diagnose endometriosis is through laparoscopy. During the outpatient minor surgery, Dr. Douglas inserts a telescope into the umbilicus (belly button) so that he can visualize the pelvis and the pelvic organs to look for endometriosis.
Surgical treatment for endometriosis can be useful when the symptoms of endometriosis are severe or if it has caused infertility. If endometriosis is found, then Dr. Douglas can use cauteries, lasers, scissors, and other instruments to remove the endometriosis. Occasionally, advanced endometriosis will require a more major surgery called a laparotomy. With the laparotomy, an incision is made in the abdomen, and the abdomen is opened in a fashion similar to a c-section or a hysterectomy. Once Dr. Douglas opens the abdomen, he can remove areas of endometriosis, freeing the scar tissue restricting the ovaries, fallopian tubes and uterus. In many cases, those who undergo surgery no longer experience the pain associated with endometriosis. Also, many patients can conceive after surgery for endometriosis
Read more about Endometriosis and Infertility: Can Surgery Help?
Medical Treatment for Endometriosis
Other treatments for endometriosis are strictly medical, meaning they do not require surgery. Once-a-month injections can turn off the female hormones estrogen and progesterone, which will stop the progression of the disease. This treatment does require approximately 4 to 6 months of injections. Many times, the side effects can be fairly severe because a woman with no female hormones will have symptoms of menopause, complete with hot flashes, vaginal dryness, joint aches and mood changes.
Gonadotropin-releasing hormone analogs (GnRH analogs)
Designed to suppress estrogen production by the ovaries, gonadotropin-releasing hormone analogs (GnRH analogs) stop the secretion of hormones from the pituitary gland. As a result, menstrual periods stop, mimicking menopause and menopausal symptoms may begin. Fortunately, by adding small amounts of oral estrogen and progesterone, patients can avoid many of the annoying side effects from this GnRH-induced menopause. Both nasal (Synarel ®) and injectable forms of GnRH agonists are available.
Oral contraceptive pills
Oral contraceptive pills, or birth control pills, are also used to treat endometriosis. By adding extra progesterone and estrogen, we can suppress the menstrual cycle and decrease the endometrioses. Sometimes, women who have severe menstrual pain may take these pills continuously, which means skipping the placebo (sugar pill) portion of the packet to stop any menstrual periods. Occasionally, women may experience weight gain, breast tenderness, nausea, and irregular bleeding. Oral contraceptive pills are usually well-tolerated in patients with endometriosis.
Pregnancy is the best treatment for endometriosis!
An optimal treatment for endometriosis is pregnancy, working as well as surgery or monthly Lupron shots. However, if a patient cannot conceive without surgery or Lupron, then this is not necessarily an option. We always try to help the women get pregnant as the first line of treatment for endometriosis. If that does not succeed, Dr. Douglas would likely suggest surgery or Lupron.
