Endometriosis - How To Handle It?

When endometrial tissue that usually grows inside the uterus, starts growing outside uterus, it is called Endometriosis. Pain during or before periods, pain during intercourse, pain while urinating or bowel movements, heavy bleeding, infertility are some of the symptoms of endometriosis.

Treatment of endometriosis usually depends on the following factors:

1. Age of female
2. Severity of symptoms
3. Duration of the symptoms
4. Future plans for children/ fertility
5. Associated pathologies

Accordingly, the doctor might choose any of the treatment options like:

1. Medication for Pain: If the symptoms are mild, then the doctor will prescribe some pain-relieving medications like Nonsteroidal anti-inflammatory drugs (e.g. Diclofenac) or anti-spasmodics(e.g.drotaverine)
2. Hormone Therapy: Hormone therapy is effective, but once you stop them, your symptoms may recur. Some of the hormone therapies include: 
   1. Hormonal Contraceptive pills: Useful in controlling the hormones that are responsible for endometrial tissue growing outside the uterine cavity.
   2. Medroxyprogesterone: This helps to counter effect estrogen hormone which is responsible for endometrial tissue growth.
   3. Gonadotropin-releasing hormone (GnRH) agonists: Gonadotropin hormones that stimulate ovaries are blocked by these. They bring down oestrogen levels and hence symptoms. It can cause an absence of menstruation in some females which is reversible.
   4. Danazol: It is synthetic androgen, suppresses growth of endometrial tissue temporarily.  However, Danazol may not be a favourable option because of its side effects. Females should avoid pregnancy while on this drug.
   5. Dienogest: This newer progesterone molecule, which does not have major side effects and is approved for use in endometriosis.
   6. Other medications like selective progesterone receptor modulators, immunomodulators, anti-angiogenic factors are being evaluated.
3. Conservative surgery: If you are trying to conceive, then surgical excision or ablation of endometrial tissue is one treatment option. Suboptimal surgery with the conservation of maximum ovarian tissue is considered suitable in such cases.
4. Hysterectomy: In severe endometriosis cases where female has completed her family, hysterectomy is offered wherein the uterus, cervix & if required ovaries can be removed.