Endometriosis Treatments, Tests, Surgery, Pregnancy, Medications, and More

Endometriosis is a lifelong condition so it is important to develop a plan to manage it based on the extent of the disease, severity of pain and potential plans for pregnancy. Since it is a chronic disease, it cannot be cured, but there are options for different types of medications to ease endometriosis pain and  help you feel better. Some need a prescription. Others you can buy “over the counter.” Your doctor may recommend that you try more than one kind.

Pain Medication

If your symptoms are mild, your doctor will likely suggest you take a pain reliever. These may include NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or naproxen.

Sometimes endometriosis pain can be severe. So, if you try pain meds that you can buy without a prescription and you don’t get enough relief, your doctor will consider whether you need a prescription for a stronger type of medicine.

Hormone Birth Control

Taking hormone birth control can stop the heavy menstrual bleeding that generally accompanies endometriosis. Your doctor may advise you to take hormonal birth control on a continuous basis for three or more months to prevent you from having your period.

The most common hormones that doctors prescribe for endometriosis include:

Birth control pills, patches, and vaginal rings. These contraceptives include both estrogen and progestin.

Progestin-only contraceptives. These include pills, shots, and an IUD (intrauterine device). These medicines can cut down on pain, as most women don’t have a period while taking these medicines, or at least have fewer periods.

Hormone therapy can cause side effects such as weight gain, depression, acne, body hair, and irregular bleeding. You should talk with your doctor about the risks and benefits. Also, if you stop taking this type of medicine, your symptoms may come back. Tell your doctor if that happens.

Gonadotroin-releasing Hormone (GnRH) Analogues

If your pain is not controlled with NSAIDS and hormone birth control, your doctor may suggest a gonadotroin-releasing hormone (GnRH) analogue. This medication causes your ovaries to stop producing estrogen, which in turn causes the endometriosis tissue to shrink. Over 80% of women using this treatment had their pain reduced, including those with severe pain. GnRH analogues also cause you to experience temporary menopause so they are not used if you are trying to become pregnant.

There are 2 types of GnRH analogues: GnRH agonists and antagonists.

Examples of GnRH agonist analogue include:

Examples of GnRH antagonist analogue include:

• Elagolix (Orilissa) — Tablet taken because of bone density loss that can increase the risk of fractures. It is taken by mouth one to two times a day, depending on your symptoms

Doctors limit the number of months these meds are taken because of bone density loss that can increase the risk of fractures. 

Androgen Receptor Agonist

The medication danazol (Danocrine)helps stop your body from releasing hormones that it uses to help bring about your period and increases your immune system. You need to be on birth control while you take it to prevent pregnancy. If you get pregnant while taking danazol, it could cause a female baby to have male traits.

Aromatase Inhibitors

Aromatase is a chemical that boosts your body’s estrogen production. Aromatase inhibitors block it, which lowers your estrogen level.  These medicines aren’t routinely used to treat endometriosis. But in some cases, doctors recommend it “off label” in addition to hormonal therapy to manage endometriosis pain, as long as you aren’t planning to get pregnant while on this treatment.

What is ORILISSA® (elagolix)? – Treatment for 3 Endometriosis Symptoms

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about ORILISSA?

ORILISSA may cause serious side effects, including bone loss and effects on pregnancy:

• Bone Loss (decreased Bone Mineral Density [BMD])
  While you are taking ORILISSA, your estrogen levels will be low. This can lead to BMD loss. If you have bone loss on ORILISSA, your BMD may improve after stopping ORILISSA, but may not recover completely. It is unknown if these bone changes could increase your risk for broken bones as you age. For this reason, your healthcare provider (HCP) may limit the length of time you take ORILISSA. Your HCP may order a DXA scan to check your BMD.
• Effects on Pregnancy
  Do not take ORILISSA if you are trying to become or are pregnant, as your risk for early pregnancy loss may increase. If you think you are pregnant, stop taking ORILISSA right away and call your HCP. ORILISSA may change your menstrual periods (irregular bleeding or spotting, a decrease in menstrual bleeding, or no bleeding at all), making it hard to know if you are pregnant. Watch for other signs of pregnancy, such as breast tenderness, weight gain, and nausea. ORILISSA does not prevent pregnancy. You will need to use effective hormone-free birth control (such as condoms or spermicide) while taking ORILISSA and for 28 days after stopping ORILISSA. Birth control pills that contain estrogen may make ORILISSA less effective. It is unknown how well ORILISSA works while on progestin-only birth control.

Do not take ORILISSA if you:

• Are pregnant, have osteoporosis, have severe liver disease, are taking medicines called organic anion transporting polypeptide (OATP) 1B1 inhibitors that are known or expected to significantly increase the blood levels of elagolix, the active ingredient in ORILISSA (ask your HCP if you are not sure if you are taking one of these medicines), or have had a serious allergic reaction to ORILISSA or any of the ingredients in ORILISSA. See the end of the Medication Guide for a complete list of ingredients in ORILISSA. Ask your HCP if you are not sure.

What should I tell my HCP before taking ORILISSA?

Tell your HCP about all of your medical conditions, including if you:

• Have or have had broken bones or other conditions that may cause bone problems; have or have had depression, mood problems, or suicidal thoughts or behavior; have liver problems; think you may be pregnant; or are breastfeeding or plan to be. It is unknown if ORILISSA passes into breast milk. Talk to your HCP about the best way to feed your baby if you take ORILISSA.

Tell your HCP about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Especially tell your HCP if you take birth control that contains hormones. Your HCP may advise you to change your method of birth control.

What are the possible side effects of ORILISSA?

ORILISSA can cause serious side effects including:

• Suicidal thoughts, actions, or behavior, and worsening of mood. Call your HCP or get emergency medical help right away if you have any of these symptoms, especially if they are new, worse, or bother you: thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, or other unusual changes in behavior or mood. You or your caregiver should pay attention to any changes, especially sudden changes in your mood, behaviors, thoughts, or feelings.
• Abnormal liver tests. Call your HCP right away if you have any of these signs and symptoms of liver problems: yellowing of the skin or the whites of the eyes (jaundice), dark amber-colored urine, feeling tired, nausea and vomiting, generalized swelling, right upper stomach area pain, or bruising easily.

The most common side effects of ORILISSA include: hot flashes and night sweats, headache, nausea, difficulty sleeping, absence of periods, anxiety, joint pain, depression, and mood changes.

These are not all of the possible side effects of ORILISSA. This is the most important information to know about ORILISSA. For more information, talk to your HCP.

Take ORILISSA exactly as your HCP tells you. Tell your HCP if you have any side effect that bothers you or that does not go away. Call your doctor for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.

If you are having difficulty paying for your medicine, AbbVie may be able to help. Visit AbbVie.com/myAbbVieAssist to learn more.

US-ORIL-210096

What is Endometriosis? | ORILISSA® (elagolix)

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about ORILISSA?

ORILISSA may cause serious side effects, including bone loss and effects on pregnancy:

• Bone Loss (decreased Bone Mineral Density [BMD])
  While you are taking ORILISSA, your estrogen levels will be low. This can lead to BMD loss. If you have bone loss on ORILISSA, your BMD may improve after stopping ORILISSA, but may not recover completely. It is unknown if these bone changes could increase your risk for broken bones as you age. For this reason, your healthcare provider (HCP) may limit the length of time you take ORILISSA. Your HCP may order a DXA scan to check your BMD.
• Effects on Pregnancy
  Do not take ORILISSA if you are trying to become or are pregnant, as your risk for early pregnancy loss may increase. If you think you are pregnant, stop taking ORILISSA right away and call your HCP. ORILISSA may change your menstrual periods (irregular bleeding or spotting, a decrease in menstrual bleeding, or no bleeding at all), making it hard to know if you are pregnant. Watch for other signs of pregnancy, such as breast tenderness, weight gain, and nausea. ORILISSA does not prevent pregnancy. You will need to use effective hormone-free birth control (such as condoms or spermicide) while taking ORILISSA and for 28 days after stopping ORILISSA. Birth control pills that contain estrogen may make ORILISSA less effective. It is unknown how well ORILISSA works while on progestin-only birth control.

Do not take ORILISSA if you:

• Are pregnant, have osteoporosis, have severe liver disease, are taking medicines called organic anion transporting polypeptide (OATP) 1B1 inhibitors that are known or expected to significantly increase the blood levels of elagolix, the active ingredient in ORILISSA (ask your HCP if you are not sure if you are taking one of these medicines), or have had a serious allergic reaction to ORILISSA or any of the ingredients in ORILISSA. See the end of the Medication Guide for a complete list of ingredients in ORILISSA. Ask your HCP if you are not sure.

What should I tell my HCP before taking ORILISSA?

Tell your HCP about all of your medical conditions, including if you:

• Have or have had broken bones or other conditions that may cause bone problems; have or have had depression, mood problems, or suicidal thoughts or behavior; have liver problems; think you may be pregnant; or are breastfeeding or plan to be. It is unknown if ORILISSA passes into breast milk. Talk to your HCP about the best way to feed your baby if you take ORILISSA.

Tell your HCP about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Especially tell your HCP if you take birth control that contains hormones. Your HCP may advise you to change your method of birth control.

What are the possible side effects of ORILISSA?

ORILISSA can cause serious side effects including:

• Suicidal thoughts, actions, or behavior, and worsening of mood. Call your HCP or get emergency medical help right away if you have any of these symptoms, especially if they are new, worse, or bother you: thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, or other unusual changes in behavior or mood. You or your caregiver should pay attention to any changes, especially sudden changes in your mood, behaviors, thoughts, or feelings.
• Abnormal liver tests. Call your HCP right away if you have any of these signs and symptoms of liver problems: yellowing of the skin or the whites of the eyes (jaundice), dark amber-colored urine, feeling tired, nausea and vomiting, generalized swelling, right upper stomach area pain, or bruising easily.

The most common side effects of ORILISSA include: hot flashes and night sweats, headache, nausea, difficulty sleeping, absence of periods, anxiety, joint pain, depression, and mood changes.

These are not all of the possible side effects of ORILISSA. This is the most important information to know about ORILISSA. For more information, talk to your HCP.

Take ORILISSA exactly as your HCP tells you. Tell your HCP if you have any side effect that bothers you or that does not go away. Call your doctor for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.

If you are having difficulty paying for your medicine, AbbVie may be able to help. Visit AbbVie.com/myAbbVieAssist to learn more.

US-ORIL-210096

Get Personalized Support with Orilissa® Complete

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about ORILISSA?

ORILISSA may cause serious side effects, including bone loss and effects on pregnancy:

• Bone Loss (decreased Bone Mineral Density [BMD])
  While you are taking ORILISSA, your estrogen levels will be low. This can lead to BMD loss. If you have bone loss on ORILISSA, your BMD may improve after stopping ORILISSA, but may not recover completely. It is unknown if these bone changes could increase your risk for broken bones as you age. For this reason, your healthcare provider (HCP) may limit the length of time you take ORILISSA. Your HCP may order a DXA scan to check your BMD.
• Effects on Pregnancy
  Do not take ORILISSA if you are trying to become or are pregnant, as your risk for early pregnancy loss may increase. If you think you are pregnant, stop taking ORILISSA right away and call your HCP. ORILISSA may change your menstrual periods (irregular bleeding or spotting, a decrease in menstrual bleeding, or no bleeding at all), making it hard to know if you are pregnant. Watch for other signs of pregnancy, such as breast tenderness, weight gain, and nausea. ORILISSA does not prevent pregnancy. You will need to use effective hormone-free birth control (such as condoms or spermicide) while taking ORILISSA and for 28 days after stopping ORILISSA. Birth control pills that contain estrogen may make ORILISSA less effective. It is unknown how well ORILISSA works while on progestin-only birth control.

Do not take ORILISSA if you:

• Are pregnant, have osteoporosis, have severe liver disease, are taking medicines called organic anion transporting polypeptide (OATP) 1B1 inhibitors that are known or expected to significantly increase the blood levels of elagolix, the active ingredient in ORILISSA (ask your HCP if you are not sure if you are taking one of these medicines), or have had a serious allergic reaction to ORILISSA or any of the ingredients in ORILISSA. See the end of the Medication Guide for a complete list of ingredients in ORILISSA. Ask your HCP if you are not sure.

What should I tell my HCP before taking ORILISSA?

Tell your HCP about all of your medical conditions, including if you:

• Have or have had broken bones or other conditions that may cause bone problems; have or have had depression, mood problems, or suicidal thoughts or behavior; have liver problems; think you may be pregnant; or are breastfeeding or plan to be. It is unknown if ORILISSA passes into breast milk. Talk to your HCP about the best way to feed your baby if you take ORILISSA.

Tell your HCP about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Especially tell your HCP if you take birth control that contains hormones. Your HCP may advise you to change your method of birth control.

What are the possible side effects of ORILISSA?

ORILISSA can cause serious side effects including:

• Suicidal thoughts, actions, or behavior, and worsening of mood. Call your HCP or get emergency medical help right away if you have any of these symptoms, especially if they are new, worse, or bother you: thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, or other unusual changes in behavior or mood. You or your caregiver should pay attention to any changes, especially sudden changes in your mood, behaviors, thoughts, or feelings.
• Abnormal liver tests. Call your HCP right away if you have any of these signs and symptoms of liver problems: yellowing of the skin or the whites of the eyes (jaundice), dark amber-colored urine, feeling tired, nausea and vomiting, generalized swelling, right upper stomach area pain, or bruising easily.

The most common side effects of ORILISSA include: hot flashes and night sweats, headache, nausea, difficulty sleeping, absence of periods, anxiety, joint pain, depression, and mood changes.

These are not all of the possible side effects of ORILISSA. This is the most important information to know about ORILISSA. For more information, talk to your HCP.

Take ORILISSA exactly as your HCP tells you. Tell your HCP if you have any side effect that bothers you or that does not go away. Call your doctor for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.

If you are having difficulty paying for your medicine, AbbVie may be able to help. Visit AbbVie.com/myAbbVieAssist to learn more.

US-ORIL-210096

Treatment options for endometriosis – InformedHealth.org

Although there is currently no cure for endometriosis, various things can be done to relieve the symptoms and improve quality of life. The choice of treatment mainly depends on whether the woman would like to become pregnant.

A woman’s choice of endometriosis treatment will greatly depend on her personal situation. If symptoms like pain and cramping are the main problem, many different symptom-relieving treatments can be considered. These include painkillers, hormones or surgery. Hormone treatment isn’t suitable for women who would like to become pregnant, though.

None of the available treatments are a guaranteed cure. It often takes some time before women find a treatment that provides enough symptom relief and has side effects that are acceptable to them.

Treatment with medication

Treatment with medication mainly aims to relieve or stop bad pain and cramps around the time of the woman’s monthly period. This can be done using painkillers and hormone drugs that suppress ovulation (stop eggs from being released from the ovaries). If a woman has recurring, but not extremely bad, pain in her abdomen (lower belly), painkillers or hormonal contraceptives like “the pill” can provide noticeable relief. These medications are often very well tolerated and are therefore usually suitable for young women who have endometriosis. If they don’t relieve the symptoms enough, stronger medications can be considered.

Painkillers

A group of painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs) are often used to treat period pain, as well as endometriosis. These painkillers include ibuprofen, diclofenac and acetylsalicylic acid (ASA – the drug in medicines like Aspirin). Some of these drugs can be bought “over the counter” in pharmacies, others are only available on prescription, particularly if taken in higher doses.

NSAIDs can provide effective period pain relief and are usually well tolerated. But there is hardly any research on whether they also help relieve pain caused by endometriosis. These medications can cause side effects such as stomach problems, nausea and headaches. ASA also prevents blood from coagulating (clotting). For these reasons, people shouldn’t take painkillers frequently or over long periods of time without consulting their doctor.

If women have more severe pain, drugs known as opioids are sometimes used too. Opioids act in a similar way to pain-relieving substances made in the body, influencing pain perception in the brain. These drugs are only allowed to be used if prescribed by a doctor. There is a risk of becoming dependent on them, particularly stronger kinds, if they are taken for long periods of time. Possible side effects include nausea, vomiting, constipation, tiredness, dizziness and changes in blood pressure. There is currently no reliable research on the effectiveness of these painkillers in the treatment of endometriosis.

Hormone therapy

Hormone-based drugs suppress the production of hormones in women’s ovaries, preventing ovulation (the release of eggs) and their monthly period. They aren’t suitable for women who would like to become pregnant. Hormone treatments used in endometriosis include:

• particular drugs that prevent ovulation, such as the pill or contraceptive patch,

• progestins,

• GnRH analogues (agonists), and

• androgenic substances.

Hormone treatments can prevent the mucous membranes in endometrial implants (endometriosis tissue) from building up, and this can relieve the pain. It’s not clear whether these medications can also make the endometrial implants get smaller or disappear completely, though. Endometriosis symptoms often return when women stop hormone therapy. Contraceptives like the pill, contraceptive patch, birth control implant and progestins are suitable for use in long-term hormone therapy.

The birth control pill

Most contraceptive pills have been proven to relieve endometriosis-related pain. But if a woman has bad period pain (dysmenorrhea), the period-like bleeding at the end of a pill cycle – known as withdrawal bleeding – can still be painful. The main side effects of the pill include headaches, fluid retention and breast tenderness.

Some types of contraceptive pill can be used to suppress a woman’s monthly hormone cycle and period for a longer amount of time too. To do so, they are taken continuously, without any breaks – or with less frequent breaks – between cycles. The continuous use of the pill is sometimes referred to as an “extended-cycle regimen.” Because this way of using the pill hasn’t been approved in Germany, it is considered to be “off-label use” (non-approved use). Drugs which are used off-label might not be covered by health insurance funds in Germany.

GnRH analogues (agonists)

Hormone drugs known as GnRH (gonadotropin-releasing hormone) analogues or GnRH agonists can relieve endometriosis symptoms too. But they have stronger side effects than the pill: They reduce the production of female sex hormones so much that they often cause problems related to estrogen deficiency. These are similar to the problems women may have during menopause, such as hot flashes, sleep problems, vaginal dryness and mood swings.

When used over longer periods of time, GnRH analogues may also reduce women’s bone density. Research suggests that their bone density returns to normal within two years of stopping this treatment. If a woman uses GnRH analogues for longer than six months, she can also start hormone therapy with low doses of estrogen at the same time. This approach is called “add-back therapy” and aims to reduce problems associated with estrogen deficiency.

Progestins and the LNG-IUS

Drugs containing the hormone progestin also relieve pain in endometriosis. Progestins can have side effects like spotting (light period-like bleeding between cycles), weight gain, feeling down and reduced sexual desire.

There is a progestin-containing coil (the LNG-IUS, short for levonorgestrel-releasing intrauterine system) which can be inserted into the womb. In the treatment of endometriosis, the LNG-IUS has only been studied as an additional treatment to surgery. When combined with surgery, it can relieve endometriosis symptoms better than surgery alone. The LNG-IUS is also used as a contraceptive. This has been shown to cause side effects such as spotting, abdominal pain, headaches and breast tenderness.

Danazol, a drug that is similar to the male sex hormone testosterone, is no longer available in Germany because it can have severe side effects.

Surgery

Generally speaking, endometriosis can be treated surgically using a relatively gentle procedure called a laparoscopy. Alternatively, a surgical procedure known as laparotomy, which involves cutting through the wall of the abdomen (tummy), may be carried out instead. In both approaches, the endometrial implants are removed under general anesthesia using heat – either produced by a laser or an electric current running through a probe (diathermy). It isn’t clear whether one of these approaches is better than the other.

The surgical removal of endometrial implants and endometriosis-related cysts in the ovaries (endometriomas) appears to relieve pain in mild to moderate endometriosis. Research suggests that removing endometrial implants during a laparoscopy can also improve fertility somewhat.

In about 20 out of 100 women, though, endometrial implants grow again within five years of surgery. This can cause endometriosis-related problems again too. In about 1 out of 100 women, the surgery leads to organ injuries or other complications such as infections or heavy bleeding.

Severe endometriosis that also affects the bowel and/or bladder is rare. Too little research has been done to be able to say for sure which of the surgical treatment approaches is most effective in this kind of endometriosis.

Procedures such as “laparoscopic uterine nerve ablation” (LUNA) are sometimes used in women who have very severe symptoms. LUNA is carried out during laparoscopic surgery and involves cutting nerve fibers in the womb that carry pain signals. According to current research, though, it appears that this procedure doesn’t relieve symptoms like period pain and pain during or after sex.

Medication before and after laparoscopy

Sometimes doctors suggest that women take additional hormones before or after having a laparoscopy. This is meant to shrink endometrial implants, as well as possibly reduce the activity of endometrial tissue which hasn’t been removed and prevent new tissue from growing. But research hasn’t found this combination of medication and laparoscopic surgery to have any advantages over laparoscopic surgery alone: It didn’t reduce pain or improve women’s chances of getting pregnant. Some studies found that women had more side effects if they also took the medication, though.

Removal of the womb and ovaries

If women have endometrial implants in their womb, and these are causing severe symptoms, they may consider having surgery to remove their womb (a hysterectomy). Endometrial implants near to the womb can be removed at the same time.

Most women only consider having a hysterectomy if their endometriosis is a real problem in everyday life, other treatments have failed, and they are sure that they don’t want to have any (more) children. The woman’s age plays an important role when deciding whether or not to have a hysterectomy. And having this kind of surgery only makes sense if it is likely to lead to an improvement in symptoms.

Removing the womb alone doesn’t guarantee that the endometriosis will be gone afterwards. If the fallopian tubes and ovaries aren’t removed too, women might still have endometriosis symptoms. So they are faced with another difficult decision: Removing both ovaries causes the production of female sex hormones to stop, leading to sudden early menopause. Menopause normally starts between the ages of 40 and 50. The average age at which women have their last period is 51.

Women who have their womb removed usually don’t also have their ovaries removed, to keep up the production of hormones.

If the ovaries are removed too, then any remaining endometrial implants in the body stop getting the hormones they need to grow. But the general problems caused by the drop in hormones after this operation can be so severe that some women decide to take estrogen. This hormone therapy might make the endometriosis symptoms return.

As with all surgical procedures done using an anesthetic, surgery for endometriosis can also lead to complications like organ damage, bleeding or infections. These occur in about 5 out of 100 women.

Other treatments for pain relief

Because none of the treatments for endometriosis are guaranteed to work and they all have potential disadvantages, many women try out various products and methods – including those that are said to help relieve period pain. But there is no reliable proof that the “complementary” or alternative medicine approaches and relaxation techniques described below can relieve endometriosis symptoms. Some of them, for instance particular herbal products, can have side effects too.

Many of them take up a lot of time and you have to pay for them yourself. Others simply give women the opportunity to relax and do something they enjoy. The approaches that haven’t been reliably proven to relieve endometriosis symptoms include:

• “Transcutaneous electrical nerve stimulation” (TENS): This aims to influence pain perception using small electric currents.

• General relaxation exercises, or techniques like yoga or tai chi.

• Procedures such as chiropractic treatment, relaxation techniques and pain management training.

• Lifestyle changes such as getting more exercise, reducing stress or changing your diet.

Household remedies like applying heat (for example by using hot water bottles, heat packs or taking a warm bath) help to reduce pain in some women. They find that heat has a relaxing, soothing effect and relieves cramps.

Options for women who would like to become pregnant

Women are considered to have fertility problems if they have not become pregnant after having regular unprotected sex for a year. There are many possible reasons for infertility. Endometrial implants affecting the function of the ovaries and fallopian tubes is just one of them.

If a woman who has endometriosis would like to get pregnant, hormone therapy is not a treatment option. This is because hormone therapy either has a contraceptive effect or greatly reduces the chances of becoming pregnant.

So the treatment options for women who would like to have (more) children include painkillers and laparoscopic surgery to remove as many endometrial implants as possible. Research suggests that laparoscopic surgery to remove visible endometrial implants and cysts in women with severe endometriosis can increase their chances of getting pregnant naturally. There is also some evidence that surgically removing endometrial implants from the ovaries increases the chances of becoming pregnant too.

In milder forms of endometriosis, where the ovaries and fallopian tubes are not affected, it is not clear whether endometrial implants reduce fertility at all. So it is also not clear whether surgery would help in this case.

Infertility can be treated with medications that help eggs to mature and be released (ovulation) or medications that influence the hormone progesterone. This kind of hormone therapy stimulates the function of the ovaries.

If it doesn’t work, IVF (in vitro fertilization) treatment may be considered. This treatment involves taking egg cells from the woman’s ovaries, and then preparing the egg cells and exposing them to the man’s sperm in a laboratory. Any fertilized eggs are later placed inside the woman’s womb. The chances of IVF being successful are somewhat lower in women who have a severe form of endometriosis than they are in women who don’t have endometriosis.

A second medical opinion can help if you’re not sure

If you still feel unsure about what treatment is most suitable – even after consulting a doctor and possibly getting a recommendation for a particular treatment – you can get a second medical opinion. This can be a particularly good idea if a hysterectomy (surgery to remove the womb) is recommended. The most suitable choice of treatment will not only depend on your medical circumstances, but  also very much on your individual situation and preferences. Our decision aid may help here. It briefly summarizes and compares the main pros and cons of the different treatments.

Sources

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

Pain Relief Medication – Endometriosis News

Endometriosis is a disease characterized by the growth of tissue that resembles the uterine lining (the endometrium) but this growth occurs outside the uterus. These abnormal growths or lesions respond the same way as the normal endometrium to the hormonal changes of the menstrual cycle. However, being outside the uterus, the lesions cannot shed properly, which lead to inflammation and pain.

No cure is currently available for endometriosis, but treatments can help reduce symptoms. Many patients with endometriosis take pain medication, such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioid narcotics.

What are NSAIDs?

NSAIDs are over-the-counter pain relief medications, which are usually the first line of treatment for endometriosis-associated pain.

They act to reduce inflammation and pain by targeting a group of enzymes called cyclooxygenases. In this way, NSAIDs prevent further pain and inflammation but cannot treat the inflammation that has already occurred. Therefore, they are most effective if taken before inflammation has begun. Many women start taking NSAIDs the day before their menstrual cycle begins to reduce pain during the cycle.

Several NSAIDs used by women with endometriosis include ibuprofen, naproxen, and diclofenac. Many companies produce these generic formulations.

What are opioid narcotics?

Opioid narcotics are medications that interact with the opioid receptors in the brain and reduce the perception of pain by altering the sensitivity of the nerve cells to pain signals. Most opioid narcotics are only available through prescription because they are highly addictive and can cause serious side effects, including nausea, drowsiness, headache, stomach upset, dizziness, and impaired judgment. Opioid narcotics are not recommended for long-term use but may be needed for the treatment of severe pain caused by endometriosis.

Opioid narcotics that may be prescribed to patients with endometriosis include hydrocodone, oxycodone, codeine, and hydromorphone.

Last updated: August 1, 2019

***

Endometriosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Emily holds a Ph.D. in Biochemistry from the University of Iowa and is currently a postdoctoral scholar at the University of Wisconsin-Madison. She graduated with a Masters in Chemistry from the Georgia Institute of Technology and holds a Bachelors in Biology and Chemistry from the University of Central Arkansas.
Emily is passionate about science communication, and, in her free time, writes and illustrates children’s stories.

Drug Therapy for Endometriosis-Associated Pain

US Pharm. 2015;40(1):HS13-HS17.

ABSTRACT: Endometriosis is a debilitating condition in women that results in chronic painful symptoms and infertility. Endometriosis, which is caused by the presence of endometrial tissues outside the uterus, occurs predominantly in women of reproductive age. However, adolescents and postmenopausal women also can develop it. Symptoms include pelvic pain, lower-back pain, dysmenorrhea, and dyspareunia. Treatment consists of drugs, surgery, or both, depending upon the severity of the symptoms. Combined hormonal contraceptives, progestins, gonadotropin-releasing hormone analogues, danazol, and nonsteroidal anti-inflammatory drugs are current pharmacologic options for pain management. These agents are effective for alleviation of pain, but they fail to prevent disease recurrence. Consequently, other therapeutic alternatives are needed for long-term benefit.

Endometriosis is a chronic, recurrent disease caused by the extrauterine presence of endometrial tissues.¹ Commonly identified in the pelvic peritoneum, the ovaries, and the septum between the rectum and the vagina, endometriosis also can occur in other organs. This estrogen-dependent condition primarily affects women of reproductive age (approximately 10% of this population), but also occurs in adolescents and in postmenopausal women.²

Several mechanisms have been suggested for the etiology of endometriosis; however, no well-defined cause has been identified. Retrograde menstruation is believed to be the most important factor in the development of endometriosis.¹ According to this theory, backward flow allows menstrual tissue to enter the peritoneal cavity and get implanted in the abdominal area; however, although 90% of women have retrograde menstruation, endometriosis does not develop in all cases. According to another premise (celomic metaplasia theory), celomic epithelium has the ability to transform into endometrial tissue. Other proposed mechanisms include transport of endometrial tissues via lymphatic ducts and blood vessels, differentiation of progenitor cells from bone marrow into endometrial tissues, and involvement of immunologic processes.¹

Risk factors associated with endometriosis include early menarche, late menopause, blockage of menstrual discharge, low birthweight, and exposure to exogenous hormonal agents.^1,2 Endometriosis can be diagnosed and staged with certainty through surgical visualization; however, other than extent of disease, staging is not a good indicator of symptoms or response to therapy.^1,2

Endometriosis is sometimes asymptomatic, but it can also cause pain symptoms and infertility.¹ (Infertility treatment, which may require surgery, medications, and assisted reproductive techniques, has been covered elsewhere.^1,2) Pain-related symptoms include chronic pelvic pain, dysmenorrhea, dyspareunia, lower abdominal pain, dyschezia, and lower-back pain. Pain management may require surgery, drug therapy, or both. Despite these interventions, symptoms of endometriosis generally recur. For this reason, the condition significantly affects quality of life and imposes economic burdens on the patient.¹

Agents commonly used in the management of endometriosis-associated pain appear in TABLES 1 and 2.³ First-line agents (TABLE 1) include combined hormonal contraceptives (CHCs; oral, transdermal patch, and vaginal ring) and progestins (depot medroxyprogesterone acetate [DMPA] and norethindrone).³ These agents are considered beneficial, are less expensive, and have fewer adverse effects than other drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used adjunctively for pain relief.³

CHCs

In a double-blind, randomized, placebo-controlled study, effects of an oral contraceptive pill (norethindrone/ethinyl estradiol [EE]) were investigated in 100 patients with endometriosis-associated dysmenorrhea for four cycles.⁴ There was a significant decrease in baseline pain scores for the CHC group versus the placebo group, suggesting that CHC therapy is an effective treatment option for dysmenorrhea.

Continuous Versus Cyclic CHC: In one study, 50 patients with recurrent dysmenorrhea despite treatment with a cyclic combined oral contraceptive (COC) were treated with a continuous oral contraceptive (desogestrel 0.15 mg/EE 0.02 mg) for 2 years. At 2-year evaluation, pain scores were significantly reduced (P <.001) with continuous treatment.⁵ Thus, continuous CHC treatment is considered more efficacious than cyclical therapy.

CHC Versus Gonadotropin-Releasing Hormone (GnRH) Analogue: In a comparison of the GnRH analogue leuprolide administered IM (along with a hormonal add-back oral agent, norethindrone) versus a continuously administered oral form of CHC for 48 weeks, both treatment groups had significantly reduced pain scores.⁶ The two treatment options were equivalent in the extent of pain reduction.⁶

Vaginal Ring Versus Transdermal Patch: A cohort study compared an etonogestrel/EE-containing vaginal ring with an norelgestromin/EE-containing transdermal patch in postoperative endometriosis patients with moderate-to-severe pelvic pain.⁷ Both treatments reduced pain; however, continuous use caused irregular bleeding. Compared with patients wearing the patch, more patients using the ring were satisfied with their results.⁷

Progestins

In a prospective, double-blind study, patients with mild endometriosis received luteal-phase oral dydrogesterone (40 or 60 mg) for 6 months.⁸ Pain scores were significantly reduced only with the higher dose, an effect still noted upon 12-month follow-up. In another study, dienogest-mediated pain reduction was comparable to that of the GnRH analogue triptorelin IM (not available in the United States).⁹ Frequencies of adverse events were similar between treatment groups.

Patients with endometriosis and moderate-to-severe pain were treated for 1 year with either IM DMPA (150 mg/3 months) or a monophasic COC (desogestrel 0.15 mg/EE 0.02 mg) plus danazol (50 mg/day po) for 21 days of a 28-day menstrual cycle.¹⁰ After 1 year, 72% of DMPA patients versus 57% of COC + danazol patients were satisfied with outcomes. A marked reduction in pain scores was reported in both groups. However, at 12-month evaluation, COC + danazol patients had greater frequency and severity of dysmenorrhea.¹⁰

In another study, endometriosis patients were treated with a levonorgestrel-releasing intrauterine system (LNG-IUS) following laparoscopic surgery to determine its effect on dysmenorrhea frequency and severity; another group underwent operative laparoscopy only.¹¹ Recurrence of moderate and severe dysmenorrhea 1 year after surgery in postoperative LNG-IUS and surgery-only patients was 10% and 45%, respectively.¹¹ LNG-IUS patients were satisfied with the outcome.

In a double-blind, randomized, controlled trial, subjects who underwent laparoscopic surgery for endometriosis were divided into two groups: 28 received LNG-IUS, and 27 were designated controls. Compared with controls, the LNG-IUS group had greater reductions in dysmenorrhea and pelvic pain according to the visual analogue scale (VAS).¹² According to the VAS, dyspareunia was comparable between groups.¹² Within 1 year following surgery, 7% and 39% of LNG-IUS and control subjects, respectively, had recurrent dysmenorrhea.¹² In a different study of LNG-IUS and DMPA, both therapies effectively controlled recurrence and symptoms of endometriosis in postoperative patients.¹³ Compliance was higher in the LNG-IUS group (13/15) versus the DMPA group (7/15). At 3 years, bone gain was observed in LNG-IUS patients, whereas DMPA patients exhibited bone loss.¹³

GnRH Analogues

Effects of IM leuprolide acetate suspension (3.75 mg) were examined in a randomized, double-blind, placebo-controlled study involving 57 endometriosis patients.¹⁴ Pelvic tenderness, pelvic pain, and dysmenorrhea were markedly relieved by GnRH analogue therapy. For example, dysmenorrhea frequency was significantly decreased (96% vs. 6%) after 6 months of leuprolide treatment.¹⁴ In a prospective, double-blind trial, IM triptorelin for 6 months in 24 subjects significantly reduced pelvic tenderness compared with placebo in 25 subjects.¹⁵ Triptorelin reduced the average area of endometriosis by 45%, with no change in the placebo group.¹⁵ In a different study, patients with laparoscopically diagnosed endometriosis received either intranasal (IN) nafarelin (400 mcg twice daily) or oral danazol (200 mg thrice daily) for 6 months. The frequency of moderate-to-severe symptoms decreased from 82% to 11% in the nafarelin group, versus an 80% to 10% reduction in the danazol group.¹⁶

In a multicenter, randomized, evaluator-blinded trial, 274 patients with endometriosis were treated with either IM leuprolide (11.25 mg) or SC DMPA (104 mg), each administered every 3 months for a total of 6 months. There were no significant differences between the treatment groups in reduction of dysmenorrhea, dyspareunia, pelvic pain, and pelvic tenderness.¹⁷ In an open-label study of 44 subjects with confirmed endometriosis, 22 underwent treatment with LNG-IUS and the rest received a monthly injection of IM leuprolide (3.75 mg) for 6 months.¹⁸ At the end of 6 months, both therapies resulted in a significant reduction in pain score, but there was no statistical difference in improvement between the agents.¹⁸ In a different trial, patients undergoing laparoscopic surgery for endometriosis received either IN nafarelin (200 mcg twice daily) or placebo for 6 months.¹⁹ An important goal of this study was to determine the time to start alternative therapy for the condition. Nafarelin therapy increased the median time to start alternative therapy (>24 months vs. 12 months for placebo), and alternative therapy was required by 31% of nafarelin patients (15/49) versus 57% (25/44) of placebo patients.¹⁹

Danazol

In a prospective, double-blind, randomized, controlled trial, 59 patients with endometriosis received oral danazol (200 mg thrice daily), oral medroxyprogesterone acetate (MPA; 100 mg daily), or placebo for 6 months. Both danazol and MPA significantly alleviated endometriosis-associated back pain, lower-back pain, and pain during defecation, with no difference between agents.²⁰ In a separate study, postoperative endometriosis patients were treated with danazol or MPA (same dosage and study duration).²¹ Again, danazol and MPA alleviated pelvic pain versus placebo.²¹ Another trial compared the effects of danazol and depot leuprorelin acetate administered for 6 months in 81 subjects with endometriosis. Both agents significantly alleviated pain and endometrial lesions, with no significant between-group differences.²² Danazol was poorly tolerated, and adverse events caused about 18% of subjects to withdraw from the trial.

Aromatase Inhibitors

Eighty-two patients with rectovaginal endometriosis were treated with oral letrozole (2.5 mg/day) and oral norethindrone acetate (2.5 mg/day) or oral norethindrone acetate (2.5 mg/day) alone for 6 months. Chronic pelvic pain and dyspareunia were significantly lessened in patients receiving combination therapy.²³ Pain symptoms, however, returned after therapy completion. Similar results were reported in another study, in which 15 patients with refractory endometriosis and pelvic pain received oral anastrozole and a CHC (levonorgestrel/EE) for 6 months.²⁴ All but one patient had a significant reduction in pain score, and estrogen production was suppressed.²⁵ From these findings, aromatase inhibitors appear to be a therapeutic option for endometriosis, and large-scale clinical studies are warranted.

NSAIDs

Despite widespread use of NSAIDs for endometriosis-associated pain, clinical trials do not support any beneficial effect from this drug class. For example, in a double-blind, four-period, crossover trial, oral naproxen (275 mg four times daily) was compared with placebo in 20 women with endometriosis-associated moderate-to-severe pain.²⁶ No statistically significant difference was observed between naproxen and placebo in relief of pain. Most likely, these agents reduce the inflammatory component of the condition.

Investigational Agents

Infliximab, a tumor necrosis factor-alpha antibody approved for treating a variety of inflammatory conditions, was found not to differ from placebo in alleviating endometriosis-related pain.²⁷ Patients who underwent conservative surgery for endometriosis were treated for 3 months with the oral immunomodulating agent pentoxyfilline.²⁸ Pain scores were significantly improved following treatment at 2- and 3-month follow-up. Treatment with the oral progesterone antagonist mifepristone (50 mg/day) for 6 months improved pelvic pain and cramps in endometriosis patients.²⁹ There was also a regression of endometrial tissue by approximately 50%.²⁹

Drug classes discussed in this article are equivalent in pain management. Because of the recurrent nature of endometriosis, however, these agents fail to provide long-term benefits to patients. The unraveling of different cellular and molecular pathways in the disease process will help scientists design and develop novel drug molecules for prevention and long-term benefit.

REFERENCES

1. Schrager S, Falleroni J, Edgoose J. Evaluation and treatment of endometriosis. Am Fam Physician. 2013;87:107-113.

2. Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010;362:2389-2398.

3. Sturpe DA, Pincus KJ. Endometriosis. In: DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 9th ed. New York, NY: McGraw Hill Education; 2014.

4. Harada T, Momoeda M, Taketani Y, et al. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril. 2008;90:1583-1588.

5. Vercellini P, Frontino G, De Giorgi O, et al. Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. Fertil Steril. 2003;80:560-563.

6. Guzick DS, Huang LS, Broadman BA, et al. Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Fertil Steril. 2011;95:1568-1573.

7. Vercellini P, Barbara G, Somigliana E, et al. Comparison of contraceptive ring and patch for the treatment of symptomatic endometriosis. Fertil Steril. 2010;93:2150-2161.

8. Overton CE, Lindsay PC, Johal B, et al. A randomized, double-blind, placebo-controlled study of luteal phase dydrogesterone (Duphaston) in women with minimal to mild endometriosis. Fertil Steril. 1994;62:701-707.

9. Cosson M, Querleu D, Donnez J, et al. Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multicenter, randomized study. Fertil Steril. 2002;77:684-692.

10. Vercellini P, De Giorgi O, Oldani S, et al. Depot medroxyprogesterone acetate versus an oral contraceptive combined with very-low-dose danazol for long-term treatment of pelvic pain associated with endometriosis. Am J Obstet Gynecol. 1996;175:396-401.

11. Vercellini P, Frontino G, De Giorgi O, et al. Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study. Fertil Steril. 2003;80:305-309.

12. Tanmahasamut P, Rattanachaiyanont M, Angsuwathana S, et al. Postoperative levonorgestrel-releasing intrauterine system for pelvic endometriosis-related pain: a randomized controlled trial. Obstet Gynecol. 2012;119:519-526.

13. Wong AY, Tang LC, Chin RK. Levonorgestrel-releasing intrauterine system (Mirena) and Depot medroxyprogesterone acetate (Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2010;50:273-279.

14. Dlugi AM, Miller JD, Knittle J. Lupron depot (leuprolide acetate for depot suspension) in the treatment of endometriosis: a randomized, placebo-controlled, double-blind study. Lupron Study Group. Fertil Steril. 1990;54:419-427.

15. Bergqvist A, Bergh T, Hogström L, et al. Effects of triptorelin versus placebo on the symptoms of endometriosis. Fertil Steril. 1998;69:702-708.

16. Nafarelin for endometriosis: a large-scale, danazol-controlled trial of efficacy and safety, with 1-year follow-up. The Nafarelin European Endometriosis Trial Group (NEET). Fertil Steril. 1992;57:514-522.

17. Schlaff WD, Carson SA, Luciano A, et al. Subcutaneous injection of depot medroxyprogesterone acetate compared with leuprolide acetate in the treatment of endometriosis-associated pain. Fertil Steril. 2006;85:314-325.

18. Ferreira RA, Vieira CS, Rosa-E-Silva JC, et al. Effects of the levonorgestrel-releasing intrauterine system on cardiovascular risk markers in patients with endometriosis: a comparative study with the GnRH analogue. Contraception. 2010;81:117-122.

19. Hornstein MD, Hemmings R, Yuzpe AA, Heinrichs WL. Use of nafarelin versus placebo after reductive laparoscopic surgery for endometriosis. Fertil Steril. 1997;68:860-864.

20. Telimaa S, Puolakka J, Rönnberg L, Kauppila A. Placebo-controlled comparison of danazol and high-dose medroxyprogesterone acetate in the treatment of endometriosis. Gynecol Endocrinol. 1987;1:13-23.

21. Telimaa S, Rönnberg L, Kauppila A. Placebo-controlled comparison of danazol and high-dose medroxyprogesterone acetate in the treatment of endometriosis after conservative surgery. Gynecol Endocrinol. 1987;1:363-371.

22. Rotondi M, Labriola D, Rotondi M, et al. Depot leuprorelin acetate versus danazol in the treatment of infertile women with symptomatic endometriosis. Eur J Gynaecol Oncol. 2002;23:523-526.

23. Ferrero S, Camerini G, Seracchioli R, et al. Letrozole combined with norethisterone acetate compared with norethisterone acetate alone in the treatment of pain symptoms caused by endometriosis. Hum Reprod. 2009;24:3033-3041.

24. Remorgida V, Abbamonte HL, Ragni N, et al. Letrozole and norethisterone acetate in rectovaginal endometriosis. Fertil Steril. 2007;88:724-726.

25. Amsterdam LL, Gentry W, Jobanputra S, et al. Anastrozole and oral contraceptives: a novel treatment for endometriosis. Fertil Steril. 2005;84:300-304.

26. Kauppila A, Rönnberg L. Naproxen sodium in dysmenorrhea secondary to endometriosis. Obstet Gynecol. 1985;65:379-383.

27. Koninckx PR, Craessaerts M, Timmerman D, et al. Anti-TNF-alpha treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial. Hum Reprod. 2008;23:2017-2023.

28. Kamencic H, Thiel JA. Pentoxifylline after conservative surgery for endometriosis: a randomized, controlled trial. J Minim Invasive Gynecol. 2008;15:62-66.

29. Kettel LM, Murphy AA, Morales AJ, et al. Treatment of endometriosis with the antiprogesterone mifepristone (RU486). Fertil Steril. 1996;65:23-28.

To comment on this article, contact [email protected].

90,000 Treatment and prevention of endometriosis – Clinic Health 365, Yekaterinburg

Treatment of endometriosis is carried out medically or with the help of surgery. The method of treatment depends on how pronounced the signs and symptoms of the disease and on the patient’s desire to become pregnant. Usually, doctors start with conservative treatment, and resort to surgery only as a last resort.

Painkillers for endometriosis

The gynecologist may prescribe over-the-counter pain relievers such as ibuprofen and others., in order to eliminate severe menstrual pain. However, if the pain does not completely subside even with the maximum dose of the drug, other treatment options can be used to relieve symptoms.

Hormone therapy for endometriosis

Taking additional hormones is an effective treatment for pain in endometriosis. Since hormone production increases and decreases during the menstrual cycle, endometrial growths increase, their cells begin to divide, and bleeding occurs.In fact, if hormone therapy has little or no effect, one should consider whether the symptoms that appear are associated with endometriosis and whether the diagnosis was correct.

The following drugs are used for the treatment of endometriosis:

Hormonal contraceptives

Birth control pills, a contraceptive patch, and a vaginal ring help control the level of hormones that are responsible for monthly growth of endometrial tissue.For most women using hormonal contraceptives, menstruation is easier and faster. Thanks to hormonal contraceptives, especially with constant use, pain in mild to moderate endometriosis decreases or disappears altogether.

Agonists and antagonists of gonadotropin-releasing hormone

These drugs block the production of ovarian stimulating hormones. This process prevents the onset of menstruation and significantly reduces estrogen levels, as a result of which endometrial growths are compressed.GnRH agonists and antagonists promote endometriosis remission during treatment and sometimes over the next few months or years. The drugs bring about artificial menopause, which in some cases has undesirable side effects, such as a feeling of heat and vaginal dryness. To reduce the side effects, a small dose of estrogen is taken along with the drugs.

Danazol

Another drug that blocks the production of hormones that stimulate the ovaries, prevents the onset of menstruation and the manifestation of symptoms of endometriosis, is danazol.It also prevents the growth of the endometrium. However, danazol is not the preferred treatment option as it can cause unwanted side effects such as acne or facial hair growth.

Medroxyprogesterone

Injection is used to prevent menstruation and the growth of endometrial growths, thereby stopping the signs and symptoms of endometriosis. Side effects include weight gain, decreased bone density, and low mood.

Aromatase inhibitors

These substances are effective in the treatment of breast cancer. In addition, they can be used in the treatment of endometriosis. Aromatase inhibitors block the conversion of hormones such as androstenedione and testosterone to estrogen and inhibit the production of estrogen by endometrial growths. This reduces the level of estrogen necessary for the development of endometriosis. According to the results of the studies conducted, aromatase inhibitors act as well as other hormonal drugs and are better tolerated.

The effect of the use of hormonal drugs is not permanent. After completion of therapy, symptoms may recur.

Surgical treatment of endometriosis

Laparoscopy

If you have endometriosis and are trying to conceive, adhesion surgery will greatly increase your chances of success. In addition, surgical treatment allows you to get rid of severe pain in endometriosis.

Thanks to minimally invasive laparoscopic surgery, it is possible to remove endometrial formations, scar tissue and adhesions without removing the reproductive organs.In laparoscopy, an optical instrument (laparoscope) is inserted through a small puncture near the navel. The doctor inserts other instruments into another small puncture, with the help of a laparoscope, he finds endometrial formations and removes them. The doctor may use a laser, small surgical instruments, or a cauter, an instrument to cauterize tissue.

Turning to assisted reproductive technologies for conception is sometimes preferable to minimally invasive surgery.Doctors often recommend this solution if surgery hasn’t worked.

Hysterectomy

For severe endometriosis, the best treatment option is a hysterectomy (removal of the uterus) and removal of both ovaries. Hysterectomy alone is also effective, but removing the ovaries prevents the risk of endometriosis recurring. Operations are carried out only in extreme cases, especially for women of reproductive age.It is impossible to get pregnant after a hysterectomy.

In the presence of endometriosis, diagnostic laparoscopy will help establish the amount, size and location of endometrial tissue outside the uterus. This information will allow the doctor to suggest possible treatment options. Sometimes the signs and symptoms are so obvious that diagnostic laparoscopy is unnecessary.

Lifestyle and home treatment of endometriosis

If the pain persists or if it takes some time to find an effective method of treatment, you can try to get rid of the discomfort at home.A warm bath and heating pad can help relax your pelvic muscles and relieve pain.

It is better to be observed by a doctor with whom you feel confident. Before starting treatment, you can also get the opinion of another doctor so that you know all the possible options and consequences.

How to cope with endometriosis and where to find support

Without early diagnosis and treatment, endometriosis can have serious consequences.Painful periods can cause a woman to be absent from work or school, as well as tension in relationships. Depression, anxiety, anxiety, irritability, and feelings of helplessness can develop due to recurring pain. Infertility due to endometriosis can also lead to emotional distress. That is why it is necessary to see a doctor if endometriosis is suspected. If you are already suffering from endometriosis or are struggling with its complications, you can enroll in a support group for women suffering from endometriosis or infertility problems.Sometimes, simply talking to someone who can share your feelings and experiences can be very helpful. If you cannot find a support group in your city, search the Internet for information about such groups.

Prevention

Since the exact causes of endometriosis have not been established, there are no specific recommendations that can reduce the risk of the disease. Although it seems that in women who have given birth, endometriosis occurs less often than in women who have not given birth.

Alternative treatment for endometriosis

According to some women, pain from endometriosis is alleviated after acupuncture treatment. However, there is little scientific evidence that alternative treatments like acupuncture are effective. If you think this treatment will help you, ask your PCP to recommend an experienced acupuncturist. Find out in advance about the cost of the procedure.

For more information on endometriosis, please contact your gynecologist at the Health 365 Clinic.Yekaterinburg.

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Modern means of treating endometriosis – Carence.ru

For many women who are diagnosed with endometriosis after examination by a gynecologist, it is important to know what this term means and how it is treated.

What is endometriosis

Endometriosis is a pathological condition in which tissue normally characteristic of the inner layer of the uterus grows outside of it, leading to the development of a chronic inflammatory process.In this article, we’ll show you how to treat endometriosis.
The illustration above shows where the foci of the endometrioid tissue located outside the uterus can most often be located.

Symptoms of endometriosis

Endometriosis can develop in different ways. So, some of the patients with this diagnosis complain of severe pain in the small pelvis and suffer from infertility, while in the other part the disease can proceed for a long time without any clinical manifestations.

Based on which the diagnosis of endometriosis of the uterus is made

The diagnosis is made on the basis of the patient’s complaints, gynecological history and symptoms, after which it is confirmed by histological examination of the affected tissue taken by biopsy.

Laparoscopy is also a method for diagnosing endometriosis, however, without biopsy data, the diagnosis made by this method cannot be considered definitive.

Modern means of treating endometriosis

Treatment of women suffering from endometriosis pursues two main goals: elimination of pain syndrome and treatment of concomitant infertility. It should be noted that in some cases, the disease cannot be cured completely.

In most cases, drugs aimed at eliminating painful sensations in the small pelvis with suspected endometriosis are prescribed empirically, that is, without histological confirmation of the diagnosis.This not entirely correct tactic is explained by the fact that many women do not want to undergo invasive intervention, preferring to take hormones and pain relievers.

Of course, the doctor can prescribe them only by excluding other possible pathologies of the pelvic organs.

Treatment of endometriosis with drugs

What drugs are used to treat pain

Pain medications used for endometriosis can be different.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are usually given first. Their action is aimed at combating the inflammation that always accompanies endometriosis, and in many cases they can help women whose pain is intermittent and not too intense.

However, NSAIDs can cause unwanted side effects such as nausea, vomiting and diarrhea. In such cases, the doctor may recommend the use of Paracetamol.If Paracetamol does not help to cope with pain, the doctor may supplement the treatment regimen with the more powerful drug Codeine, which, however, has a number of serious side effects (nausea, vomiting, drop in blood pressure, intestinal atony, withdrawal syndrome, etc.).

Symptoms and causes of endometriosis

Alternative methods of dealing with pain in endometriosis are physiotherapy, the so-called “pain modulators” and transcutaneous electroneurostimulation (TENS). Physiotherapy procedures usually consist of a set of exercises aimed at strengthening the muscles of the pelvic floor, which in some cases leads to relief of painful symptoms in patients.

Pain modulators are drugs that affect the body’s ability to experience pain. These include tricyclic antidepressants such as amitriptyline.

The mechanism of their action is quite simple: a signal is sent from the source of painful sensations in the body to the cerebral cortex and, as soon as it reaches the target, the cortex generates a sensation in response, which a person recognizes as pain. Pain modulators interrupt the path of this signal, thereby preventing impulses from occurring in the cerebral cortex, leading to the sensation of severe pain in endometriosis.

Other modern treatments for endometriosis

Transcutaneous electroneurostimulation for endometriosis

Transcutaneous electroneurostimulation (TENS) works in a similar way to antidepressants. Tiny electrodes are attached to the skin, sending out subtle electrical impulses. It is assumed that they either block signals to the cerebral cortex, or stimulate the release of endorphins, which are natural pain relievers in the human body, allowing you to significantly reduce pain in endometriosis.Some CHENS devices are so compact that they can be attached to a belt.

Studies show that in many cases their use has significantly improved the quality of life of patients. The use of TENS devices is contraindicated for people suffering from heart disease, as well as for pregnant women.

Hormonal treatment of endometriosis

As for hormonal therapy, its main goal is to reduce the level of estrogens in the body, since they stimulate the growth and spread of endometrioid tissue in endometriosis.

The use of hormonal drugs can limit the development of endometriosis and associated painful symptoms.

However, they do not in any way affect the development of the adhesive process, which often occurs in this disease and is the cause of infertility.

So, with endometriosis, hormonal drugs can be prescribed: combined oral contraceptives (COCs), levonorgestrel-releasing intrauterine system (LNG-IUD), gonadotropin-releasing hormone (GnRH), progestogens.

COC preparations contain a combination of estrogen and progestogen. They prevent ovulation, reduce pain during menstruation, and prevent unwanted pregnancies. They can be prescribed for moderate pain syndrome, long-term use is possible.

An example of an LNG-IUD is the well-known Mirena intrauterine device. It is T-shaped, inserted into the uterine cavity, and secretes levonorgestrel (a type of progestogen).

The effectiveness of the spiral lasts up to five years, while it prevents unwanted pregnancy.May cause side effects such as acne and irregular, sometimes unnecessarily long periods.

The use of GnRH preparations leads to the onset of the so-called “artificial menopause”, which is associated with a decrease in the production of estrogen in the body. At the same time, in addition to getting rid of the symptoms of endometriosis, a woman runs the risk of encountering undesirable manifestations characteristic of menopause: a decrease in sexual desire, hot flashes, atrophy of the vaginal mucosa.

Usually, these drugs are prescribed for a period of no more than six months, and after their withdrawal, all unpleasant symptoms of endometriosis may return.

Progestogens (synthetic analogs of progesterone) have been used in the treatment of endometriosis since the 50s of the last century and in many cases they can really help in the fight against this disease.

The effect is to suppress the growth of endometrioid tissue, as well as to reduce the inflammatory response. Side effects of their use can be the appearance of excess weight, sudden mood swings, and menstrual irregularities.

Surgery for endometriosis

Unfortunately, sometimes neither analgesics nor hormonal therapy can alleviate the patient’s condition. In such cases, it is necessary to resort to surgical treatment of endometriosis. However, at present, the intervention is most often minimally invasive and is performed laparoscopically: the surgeon works through small punctures in the abdominal wall, removing pathologically altered tissue using laser radiation, special gas or electric current.

After such an operation to treat endometriosis, a short recovery period follows, and there are no large ugly scars on the body. As a rule, complications do not arise, except in cases where part of the endometriotic growths has not been removed.

Laparotomy (an operation with an abdominal wall incision) is currently rarely used for endometriosis: in cases of severe disease and extensive damage to organs and tissues by endometrioid growths, as well as in the formation of multiple adhesions.

The recovery period after such an intervention is longer, but the advantage of the operation is a good overview for the surgeon, wider access to the affected organs and tissues.

Treatment of endometriosis in women after 40 years differs only in that with severe endometriosis after 40, doctors can resort to surgery, and in women of childbearing age they always try to preserve the uterus and ovaries as much as possible to ensure the ability to conceive and bear a child.

It is almost impossible to completely cure endometriosis with folk remedies, however, pain can be reduced by using folk remedies to relieve pain.

Modern medicine has numerous means of fighting endometriosis, many of which are very effective. Therefore, if you have already been diagnosed with this diagnosis, or you have any characteristic symptoms, do not waste time and contact a qualified specialist in a timely manner.The sooner effective treatments are selected, the more chances you have to avoid complications and safely cope with endometriosis.

Women with endometriosis who suffer from regular pain have a new treatment option. A new drug for the treatment of pain in endometriosis, elagolix (trademark of Orilissa), from the manufacturer AbbVie has been approved. Orilissa is the first FDA-approved drug for the treatment of moderate to severe pain associated with endometriosis in the past decade.

Endometriosis is one of the most common gynecological conditions, affecting up to 1 in 10 women of reproductive age. This disease can lead to severe pain.

The reason is simple: in women with endometriosis, excess tissue grows in the abdominal cavity that they cannot shed, as happens with the lining of the uterine cavity during menstruation.

Every month, the endometrium, the inner lining of a woman’s uterus, thickens and falls out during menstruation, if pregnancy has not occurred in this cycle.With endometriosis, this tissue thickens and bleeds, but this does not happen inside, but outside the uterus – on the fallopian tubes or even in the nose or lungs.

Since excess tissue is unable to leave the body (it cannot pass into the vagina because it does not grow in the uterus), it accumulates and leads to pain and sometimes infertility.

There is no cure for the complete cure of endometriosis yet. To manage symptoms, women are usually prescribed birth control or over-the-counter pain relievers as the first line of treatment, but they don’t always work.In severe cases of endometriosis, your doctor may suggest “excision surgery” to remove excess tissue.

Endometriosis is a disease caused by estrogen and the new drug elagolix works by lowering the level of these sex hormones. Two large, double-blind, placebo-controlled, randomized trials involving 1285 women tested whether a new drug could help women control endometriosis pain.

The results, published last year in the New England Journal of Medicine, were impressive.Before treatment, patients in these studies rated their pain from 0 (no pain) to 3 (severe pain). On average, they had a pain level of 2.2 out of 3 before taking the drug – and they experienced a 2 point reduction in pain after taking the new drug for three months.

Side effects of the new drug for endometriosis

It must be repeated that the new drug does not cure endometriosis; it only reduces the pain this gynecological disease causes.

Many women in the study had menopausal symptoms – hot flashes, headaches, insomnia – as side effects in the study, and the researchers also found that a new endometriosis drug caused bone loss.

There is also no data on the long-term effects of elagolix, because there are no trials that last more than a year. It is not yet known how the new drug is combined with other pain relievers (as trials only compared it to a placebo).

The price of Orilissa is relatively high, but for some women the risks and costs may be worth it as the available treatments for endometriosis do not always help and some have serious side effects.

When birth control pills or over-the-counter pain relievers do not help endometriosis pain, women often have to choose between a monthly injection called Lupron Depot, which can bring women into deep menopause, or Danazol, a male hormone that often causes acne and hair growth on the face.

If these endometriosis drugs are ineffective or the woman is reluctant to take them, surgery to remove excess endometrial tissue can be a very effective option. But the problem with surgical treatment is that endometriosis can recur, so women may need reoperations. The success of surgery also depends on finding a qualified and experienced surgeon, and there is always a risk of complications.

A new drug for the treatment of endometriosis is also not without risk.In trials, women who took Orilissa had greater bone loss than those who received a placebo, and this is not surprising. Like other treatments for endometriosis, it works by lowering estrogen levels.

When this happens, women experience the side effects of menopause. Hot flashes, headaches, and insomnia were most common in the trials. (Orilissa is available in two dosages – 150 mg daily or 200 mg twice daily – and women who took the higher dose were more likely to have side effects.)

But despite the side effects, for many women, a new medicine for endometriosis pain may bring long-awaited relief.

Consult your doctor before trying to relieve endometriosis with modern drugs.

Author: Kristina Solovieva

Treatment of endometriosis in women in Samara. Prices

Endometriosis is a hormone-dependent disease.It is characterized by pathological proliferation of the endometrium outside the uterus, for example, into the ovaries, intestines, bladder and other organs. Symptoms of the disease and the severity of the course depend on the place of localization of the process.

Complications provoked by endometriosis are at great risk. This includes peritonitis, inflammation and infertility. The first symptoms most often occur in women between the ages of 25 and 35. In the early stages, the disease is well treated.

Important! It is a chronic disease that affects the body as a whole.If your close female relatives have been diagnosed with endometriosis, you are at risk.

Our clinic Citylab invites you to undergo a comprehensive examination and receive quality treatment.

Symptoms

Symptoms of endometriosis can be divided into three groups: main, less typical, rare.

Main signs of the disease:

• Regular pain in the lower abdomen.
• Pain during menstruation.
• Pain during intercourse.
• Difficulties with conception, up to infertility.

Less typical:

• Brown or bloody discharge between periods.
• Blood after intercourse.
• Pain when urinating or defecating.
• Discharge of blood from the anus.
• Increase in the number of red blood cells in the urine.

Rare:

• Formation of knots on the skin.
• Hemoptysis.
• Intestinal obstruction.
• Dropsy of the kidneys.

Painful sensations in endometriosis may be temporary. Some women do not experience any discomfort at all for many years. The listed symptoms are typical for many other pathologies, which is why, in order to make an accurate diagnosis, we invite you to undergo a comprehensive examination at the Citilab clinic.

Reasons

Experts are still arguing about the causes of endometriosis.To date, there are several main theories about its origin:

• Impaired immunity and its ability to destroy foreign tissues.
• Failure of the production of hormones in the body.
• Genetic predisposition, etc.

Diagnostics

The diagnosis begins with a visual examination and anamnesis. Further, the patient may be prescribed:

• Ultrasound.
• MRI.
• Laparoscopy and tissue sampling for microscopic examination.

Treatment of endometriosis in women

Medicines for the treatment of endometriosis are selected individually for each patient, taking into account contraindications and the severity of the disease. The treatment is complex and includes the following stages:

• Taking hormonal drugs. Oral contraceptives can relieve pain and slow or stop the progression of endometriosis. It is also possible to install an intrauterine system with levonorgestrel.
• Taking drugs of gonadotropin-releasing hormone agonists.These are effective remedies, but taking them longer than 6 months is not recommended due to the large number of side effects.
• Prescribing painkillers. Not all women are required. If necessary, preference is given to non-steroidal anti-inflammatory drugs. You need to take painkillers when pain occurs.
• The use of reflexology. Many women are helped by acupuncture, laser puncture, electrical neurostimulation, etc.

The patient’s lifestyle is of great importance in the therapy of endometriosis.Without fail, the diet includes vitamins, calcium, fish oil. Physical education also helps relieve the severity of pain in endometriosis.

If hormone therapy is ineffective and the disease continues to progress, the woman is recommended to have surgery. Surgical intervention is mandatory for patients with damage to the intestines, bladder and other organs. The operation can be radical or conservative. It all depends on the condition of the woman and the complexity of the pathology.

Today it is possible to carry out the following types of operations:

• Laparotomy. It is used in severe cases. In this case, an incision is made in the anterior abdominal wall.
• Laparoscopy. Access to lesions is carried out through small incisions using special equipment.

Treatment of endometriosis in Samara at the clinic Citylab

Clinic Citylab invites you to undergo a comprehensive examination and get advice from a qualified gynecologist.Here you can:

• Undergo an initial examination and consult a doctor.
• Undergo additional examinations, which will allow you to make an accurate diagnosis and choose an effective course of therapy.
• Receive qualified treatment.

The attending physician will accompany you during all stages of therapy. Treatment of endometriosis at the Citylab clinic is carried out using modern technologies and equipment. The technique is selected individually for each patient, which allows you to get a high-quality result and avoid complications in the process.If you need endometriosis treatment, the price of the service will be announced to you by our consultants. You can also see the price list on the website.

90,000 ⚡How to Ease Endometriosis Pain Naturally❓

✅ If you have been diagnosed with endometriosis, it is important to eat a balanced diet and avoid caffeinated drinks.

❎ Certain exercises and breathing practices will help you to relieve severe pain.

Endometriosis is a fairly common disease that can cause severe pain. Fortunately, the right diet and natural remedies can ease your distress.

From this article you will learn what symptoms this disease has, how to remove pain in endometriosis and how exactly you can resist it without medication.

What is endometriosis?

Endometriosis is a disease in which the cells of the inner layer of the uterine wall (the endometrium, the one that bleeds during menstruation) grows outside of it. For example, on the ovary, fallopian tubes, or even on the bladder or intestines.

You may experience severe pain with endometriosis, as areas where endometrial cells are trapped become inflamed during menstruation and may even bleed.

Here are main symptoms of this unpleasant disease:

• Severe pelvic pain, cramps during menstruation, or chronic pain that may spread to the back or hips
• Menses more profuse than usual
• Pain during bowel movements or during sex, especially during the week before menstruation
• Nausea and vomiting a few days before the onset of menstruation
• Although there is no definite answer to the question of what causes endometriosis, scientists are inclined to the option that hormonal imbalance is to blame for everything.Probably one of the causes of this disease is too high estrogen levels.

How to Relieve Endometriosis Pain

A balanced and healthy diet is the first step in pain relief from endometriosis. Follow our advice:

• Refrain from excessive consumption of meat and dairy products. They may contain xenoestrogens that cause pain in endometriosis.
• Avoid coffee and carbonated drinks. They contain caffeine, which aggravates the symptoms of the disease.
• Eat as much fresh fruits and vegetables as possible. They contain fiber, which helps the intestines and prevents inflammation. They are also rich in vitamins, some of which can relieve pain.
• Add foods rich in omega-3 and omega-6 fatty acids to your diet. These substances control the level of prostaglandin, the hormone responsible for pain in endometriosis.Fatty acids are found in tuna, sardines, flaxseed, and pumpkin seed oil.

How to Relieve Endometriosis Pain Naturally

Here are some more ways to treat endometriosis symptoms without medication:

• Exercise to relieve stress. Constant stress can lead to hormonal disruption and thus cause painful sensations. Do yoga or other breathing exercises to get rid of worries and bad thoughts and make you feel much better.
• Acupuncture. A traditional Chinese remedy for centuries has proven effective in relieving pain in a wide variety of situations.
• Heat therapy. Apply a warm compress to the area where you have pain during your period. This will allow the muscles to relax and soothe the soreness.

If the symptoms persist and the pain only gets worse, be sure to consult your doctor!

Endometriosis – Bayer Pharmaceuticals Russia

“Lost” tissue

Endometriosis is a condition in which tissue similar in structure to the inner lining of the uterus (endometrium) occurs elsewhere, usually in the pelvis, around the uterus, in the ovaries ¹ .Endometriosis is a complex disease, the etiology of which is still not fully understood. Endometriosis worldwide affects approximately 10% of women, mostly of reproductive age. Due to the fact that endometriosis can be asymptomatic, it is difficult to estimate its true prevalence ¹ .

There are symptoms, but it is not easy to diagnose!

Endometriosis is a chronic condition that can affect your physical, sexual, psychological and social well-being.The most common symptoms of endometriosis are pelvic pain, painful, sometimes irregular or heavy periods. Possible pain during or after intercourse and impaired fertility ¹ . The discharge of their genital tract with endometriosis can be dark, smearing, bloody, appearing 3-7 days before the planned menstruation and can continue after it. Allocations can also be after intercourse. Menses are longer and more profuse. Bleeding may occur between planned periods, which is why symptoms of chronic blood loss often occur: fatigue, weakness, drowsiness and pallor of the skin.Sometimes endometriosis can cause anemia. Pain is a frequent companion of the disease. Their intensity can be different: from mild to acute pain. There is no definite localization of pain. Most often, soreness appears in the lower abdomen, but it can also radiate to the anus, to the groin area, or even to the leg. Basically, pains are observed at the beginning of a planned menstruation, and immediately after its end they disappear, but they can also be observed throughout the cycle, slightly weakening when the bleeding stops.It must be remembered that the presence of any symptom and even several at once does not give reason to diagnose endometriosis in oneself. Such factors should be taken as a signal for an urgent appeal to a specialist for the necessary examination ² .

Endometriosis is a serious medical condition. What it is dangerous and what consequences may arise usually depends on timely diagnosis and proper treatment ² . Endometriosis can sometimes be difficult to diagnose.To diagnose this disease, as a rule, ultrasound (ultrasound diagnostics) of the pelvic organs is used, and, if necessary, MRI (magnetic resonance imaging) and CT (computed tomography). The most accurate diagnostic method is laparoscopy ¹ .

Treatment options include pain relievers, nonsteroidal anti-inflammatory drugs, hormonal drugs, and / or surgery ¹ . If treatment of endometriosis with medication has failed, surgeon intervention may be required ² .To eliminate the disease and prevent its spread, the help of specialists is needed. The disease largely prevents the onset of natural pregnancy, since it is the affected mucous membranes of the uterus that do not allow the embryo to gain a foothold. In vitro fertilization with endometriosis often becomes the only way for a woman to carry a baby. The artificial insemination program is selected individually and depends on the type and degree of the disease, on the age of the expectant mother and her condition ² .

Drug for long-term therapy of endometriosis

2011 was marked by the expansion of the possibilities of drug therapy for endometriosis. Since endometriosis is a chronic recurrent disease, long-term pathogenetic therapy is required (i.e., affecting all links of a complex pathological process, and not just individual symptoms of the disease). Such drug treatment, in addition to relieving pain, should also have an acceptable tolerance and safety profile for long-term use.Such an innovation in therapy – the Vizanne drug – even after 10 years gives doctors the opportunity to create an individual treatment plan, minimize the risks of repeated surgical interventions, and improve a woman’s quality of life.

Patient Information

The body’s response to a particular drug and / or method of treatment is strictly individual. The decision to use a particular method of therapy is made by the attending physician and the well-informed patient about the benefits and risks of therapy.

1. Clinical guidelines “Endometriosis”, 2020.
2. Clinical guidelines “Endometriosis”, 2016.

90,000 Pain in the lower abdomen in women in questions and answers

06/27/2019

Pain in the lower abdomen in women in questions and answers

Lower abdominal pain is the most common complaint in gynecological practice. This symptom is not very specific, as it occurs in many diseases. Today, many have non-steroidal anti-inflammatory drugs (NSAIDs) in the medicine cabinet.The choice is wide, and the doctor and pharmacist must guide the woman in the possibilities of certain drugs and warn her, reminding her of the importance of a timely visit to the doctor, and also answer all questions.

Complaint: pain during menstruation

How it starts:
1) Per day or on the 1st day of the menstrual cycle. Lasts for the first 2 to 42 hours or throughout your period.
2) In the 2nd half of the cycle, the peak reaches during menstruation.
3) During menstruation.

How does it hurt?

The pain is often cramping in nature, but it can be aching, twitching, bursting, and can be given to the rectum.
Severe, often spasmodic pain.

What else is troubling you?

1) Irritability, depression, nausea, chilliness, dizziness, fainting, headache, swelling (possible dysmenorrhea).
2) Pain during intercourse, recurrent pain during urination, defecation (endometriosis is possible).
3) Prolonged or too intense menstrual bleeding. Sometimes bleeding outside of menstruation. There may be an increase in the volume of the abdomen and frequent urge to urinate (possible uterine fibroids).

Caution: acute pain

Acute intense and / or unilateral lower abdominal pain may indicate a gynecological emergency:
-perforation or rupture of tumors and tumor-like formations of the ovaries;
– torsion of the anatomical legs of the ovary;
– ovarian apoplexy;
– intra-abdominal bleeding;
– acute purulent diseases of the pelvic organs, etc., therefore, a doctor’s consultation is necessary.

What can hurt?

The causes of pain in the lower abdomen can be very different: pathologies of the development of the genital organs, purulent-inflammatory diseases of the uterine appendages, endometriosis, diseases of the gastrointestinal tract (GIT) and urinary system. One of the most common causes of recurrent lower abdominal pain in women is dysmenorrhea. Cyclic pain in the lower abdomen can be caused by endometriosis, polycystic ovary syndrome, sexually transmitted infections, and other serious medical conditions.Such dysmenorrhea is considered secondary, and treatment of the disease that caused it, as a rule, leads to full recovery. Primary dysmenorrhea is characterized by the appearance of cyclical pain in the lower abdomen a few hours before menstruation and in the first days of the menstrual cycle in the absence of any pathology from the pelvic organs. Primary dysmenorrhea is most common in young women.

Pain with dysmenorrhea:

– Reaches maximum intensity at the peak of bleeding.
– Can be sharp, cramping, bursting or blunt.
– Most often it is localized along the midline in the suprapubic region, but it may not be clearly localized.
– May radiate to the lumbar region, rectum or thigh.

Should we endure the pain?

The multifaceted effect of pain syndrome on the human body determines its independent clinical significance. Pain not only determines the severity of suffering and social maladjustment of the patient, but is also fraught with more serious consequences, for example, disruption of the normal function of organs, especially the cardiovascular system.It is not recommended to endure pain.

Which medicine will help?

The first stage of rational analgesic therapy is the elimination of the effect of the damaging factor (if possible), as well as suppression of the local reaction of the body to damage. For these purposes, drugs are used that block the synthesis of pain and inflammation mediators. The main mediators of inflammation – prostaglandins (PG) – are actively synthesized in the damaged area with the participation of the enzyme cyclooxygenase (COX).It is important that the causes of damage (trauma, surgery, inflammation, edema or tissue ischemia, persistent spasm of striated or smooth muscles, etc.) do not matter, therefore, the use of drugs that block COX and suppress the synthesis of proinflammatory PGs will help with any somatic or visceral pain. Well-known NSAIDs have this effect.

In the case of dysmenorrhea, one of the main pathogenetic mechanisms is a high level of PG. An increase in their ratio in the menstrual endometrium leads to a reduction in the muscle elements of the uterus.PGs are secreted in almost all tissues of the genital organs: endometrium, myometrium, endothelium of uterine vessels, tubes, etc. An increase in their level leads to an increase in the contractility of the uterus, against the background of which vasospasm, local ischemia, which is manifested by pain syndrome, occur. Moreover, the high level of PG detected in dysmenorrhea causes ischemia of other organs and tissues, which is realized in such symptoms of dysmenorrhea as headaches, dizziness, weakness, etc. In the treatment of primary dysmenorrhea, NSAIDs are among the drugs of choice.

Which is better, NSAIDs or antispasmodics?

The previously stated assumption about the comparable efficacy of antispasmodics and NSAIDs in the treatment of primary dysmenorrhea has not been experimentally confirmed. In particular, antispasmodics were inferior to NSAIDs in terms of the rate of pain relief. Currently, antispasmodics are not included in the international standards for the treatment of primary dysmenorrhea. Thus, NSAIDs are recognized as the most effective drugs in the treatment of this pathology. Among the drugs widely used for dysmenorrhea, the most common are NSAIDs with a short half-life (dexketoprofen, ketoprofen, nimesupid, diclofenac, ibuprofen, indomethacin, etc.).

Which NSAIDs are the most effective?

There is no ideal NSAID, so an individual approach is required in each specific clinical situation. On average, the therapeutic effect of different NSAIDs is the same with the appropriate dosage regimen. However, some studies have noted significant differences in individual response between individual patients. Thus, it is impossible to predict which of the NSAIDs will be most effective in a particular patient.NSAIDs are available in different dosage forms (tablets, suppositories, injections), which allows you to choose the form that is most suitable for a specific clinical situation.

How to take NSAIDs for dysmenorrhea?

In case of dysmenorrhea, NSAIDs should be started even before the onset of symptoms or at the first manifestations (in the first 48-72 hours) due to the maximum release of PG in the first 48 hours. …Irritation of the gastrointestinal mucosa can be easily prevented by taking NSAIDs after meals or milk.

Important!

Patients should not take NSAIDs:
– with erosive and ulcerative lesions of the gastrointestinal tract, especially in the acute stage;
– with severe impaired liver and kidney function;
– with cytopenias;
– with individual intolerance;
– during pregnancy.

Basic rules for the use of NSAIDs:

– application of the minimum dose efficiency for the shortest possible period of time necessary to achieve the set therapeutic goal.
– if there is no effect within 3 days of use, a doctor’s consultation is necessary. Uncontrolled and prolonged use of NSAIDs is unacceptable.

First aid for dysmenorrhea will be provided by the so-called “gold standard” NSAIDs – ibuprofen, and its encapsulated form – IBUPROFEN CAPS.

Why in capsules? The answer is simple.

IBUPROFEN CAPS is the “second modern generation” of ibuprofen in 200 mg capsules with the onset of the therapeutic effect in 15 minutes.The advantage of IBUPROFEN CAPS is the rapid onset of action. And we need to quickly eliminate the pain. In addition, the capsules conceal an unpleasant taste and ensure dosing accuracy.

When taken orally IBUPROFEN CAPS , manufactured by Minskintercaps , quickly disintegrates and dissolves with the achievement of the maximum therapeutic effect after 45-60 minutes.

Another criterion, based on which, IBUPROFEN CAPS is prescribed – the presence of a number of clinical trials in Belarus and Russia, where the drug IBUPROFEN CAPS has confirmed its biological equivalence to the original drug Nurofen ultracap.

Adults and children over 12 years of age can take Ibuprofen CAPS for pain relief 1 or 2 capsules up to three times a day, keeping the interval between doses of at least four hours.

IBUPROFEN CAPS is a modern form of ultra-fast acting ibuprofen.

based on the materials of the “Pharmacist’s Handbook” magazine, No. 2, 2017

Products by topic:
Ibuprofen CAPS
90,000 Alternative Treatments for Endometriosis | Polyclinic of the Central Clinical Hospital of the Russian Railways-Medicine

Negodova O.A.

Endometriosis is a pathological process characterized by the growth and development of tissue similar in structure and function to the endometrium, outside the boundaries of the normal localization of the mucous membrane of the uterine body.

The frequency of this disease varies widely from 12 to 50% (Strizhakov A.N., Davydov A.I., 2006; Adamyan L.V., 2006).

In the structure of ginetal endometriosis, the most common forms are endometrioid lesions of the body of the uterus and ovaries.Endometriosis is mainly diagnosed in the reproductive age, it is relatively rare in menopause, and in most patients during this period, the disease regresses.

General clinical manifestations of endometriosis are characterized by pain before and during menstruation, with irradiation to distant organs, prolonged and heavy menstruation, menstrual irregularities, infertility, subfebrile condition, anemia, urination disorder, act of deflation, chocolate vaginal discharge, sexual and emotional dysfunctions, psychoactive disorders …

Today, the treatment of endometriosis is a complex problem. Treatment issues deserve close attention, especially when the disease affects young women who are interested not only in menstrual, but also generative function.

The currently existing therapy with hormonal drugs has a number of significant drawbacks; after the termination of hormonal treatment, most patients experience a relapse of clinical symptoms.

Also noteworthy is the number of side effects and contraindications to hormone therapy.

The main group of hormonal drugs used in the treatment of endometriosis are gonadotropin releasing hormone (GnRH) agonists, luliberin antaganists, antigonadotropins, progestogens, combined oral contraceptives, antiestrogens and androgens with antiprogesterone and antiestrogenic effects (antiestrogenic).

In the conditions of the Central Polyclinic of JSC Russian Railways, we selected a group of patients with endometriosis (25 people), of which 15 people with adenomyosis (damage to the uterine body), 8 people with endometrioid cysts, 2 with retrocervical endometriosis.

All patients are women aged 23 to 43 years, of average build. 12 out of 25 had bad habits (smoking). Of these, 14 people who had previously repeatedly undergone treatment according to the generally accepted scheme in accordance with the achievements in domestic and foreign medicine. In 9 patients out of 14, symptoms recurred within a year after hormonal treatment, 6 patients (out of 14) were operated on for endometrioid ovarian cysts (in 2 cases with relapses), 2 – for retrocervical endometriosis; 11 patients had not previously received hormone therapy, due to the existing contraindications from the hemostasis system, gastrointestinal tract, as well as not being able to carry out hormone therapy, given the high cost of drugs.

All patients were treated with a drug with antiangiogenic, proapoptotic, powerful antitumor effect. This drug is Indol-3 carbinol – “Indinol” (Miraxpharm), which has the ability to normalize estrogen metabolism, inhibits pathological cell proliferation by blocking the intracellular pathways of signal transmission from growth factors.

The effect of this drug has been studied on various pathological models in studies of scientists from different countries, however, scientific studies are continuing to study its effect in adenomyosis.The drug was prescribed 2 capsules 2 times a day with meals for 3-6 months.

It is known that patients with endometriosis have common signs of immunodeficiency and autoimmunization, leading to a weakening of immune control, which create conditions for the development of foci of endometriosis. In this regard, we included the use of immunomodulating drugs in the treatment taking into account the immunogram. The drug of choice was cycloferon, which belongs to the group of low molecular weight synthetic inducers of α- and γ-interferons.

The drug was injected intramuscularly at 2.0 ml daily for 5 days, then 5 injections every other day, followed by a switch to oral administration on days 1,2,4,6 and 8 of the menstrual cycle. After 3 to 4 weeks, oral administration was resumed. We did not observe any deterioration of the state against the background of immunomodulating therapy with preserved menstrual function, although, according to some data, in a menstruating woman (without reaching “pseudomenopause”), in some cases, immunostimulation can lead to the activation of the process.

We have connected “trental” to the complex therapy – to improve microcirculation in the affected endometrium. He was prescribed 1 ton 3 times a day (4 weeks), after 3 months the course was repeated. Multivitamins “Komplevit” – 1 k per day. Patients with retrocervical endometriosis were prescribed suppositories with Longidase 3 t. ME. after 2 days on 3 No. 10, followed by a repeated course.

Assessment of the general condition was carried out after 3 months of therapy. Side effects in the form of headaches while taking indinol were observed in 1 patient, and therefore had to stop taking the drug.No other side effects were observed in anyone.

All patients noted a decrease in menstrual bleeding after 3 months of therapy, cessation of smearing discharge before and after menstruation, a decrease in pain during intercourse, dysmenorrhea. Two patients had a planned pregnancy, one of whom had an endometrioid cyst after six months of therapy. Patients are observed in the antenatal clinic at the place of residence. One patient underwent the fifth diagnostic laparoscopy, after the course of the therapy we conducted, no signs of process activation were revealed.

So, today, taking into account the peculiarities of the mechanisms of development of endometriosis, in conservative treatment, the most pathogenetically justified therapy is the therapy acting on the molecular links of pathogenesis.

Observing the patients on the background of the therapy, evaluating the positive effect on clinical symptoms, improving the quality of life, we can state that the drugs used (in combination) – indinol, immunomodulators, vitamins, drugs that improve microcirculation, can be considered as an alternative to hormonal therapy. drugs for patients who have refused hormonal treatment for endometriosis, or in the presence of contraindications to their use, as well as with relapse of clinical symptoms after therapy with GnRH agonists.

.