Endometriosis is a very distressing disease. It is defined as the growths of endometrial tissue occur outside of the uterus in the pelvic cavity. [1][26]
Over one million women (estimates range from 3% to 18% of women) in the United States are affected by it. It is mostly found in white women and commonly affected taller, thin women with a low body mass index (BMI). The risk also increases on women whom delayed their pregnancy until an older age. [1]
Patients normally suffering of pelvic pain during menstruation and intercourse that sometimes cause infertility. [26] Some symptoms include low back pain, dysmenorrhea, and heavy periods (menorrhagia). [2][7][26]
However, the cause is still unknown. [7] Endometriosis can be treated and cured. So how do medical treatments can help to overcome this disease?
Figure 1: Source: http://www.clarian.org/ADAM/doc/graphics/images/en/17061.jpg
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Endometriosis Treatment
a) Medical Treatment
Nonsteroidal anti-inflammatory drugs (NSAIDs) for example ibuprofen or naproxen sodium are commonly administrated to relieve menstrual cramping and pelvic pain. Although they do not shrink endometrial implants, they help to decrease prostaglandin productions which produce pain sensation.[4]
Most of medical treatments available depend on interruption of estrogen hormone production by the ovaries as Endometriosis occurs during menstruation. GnRH analogs and oral contraceptive pills are some examples of medications. [4]
Gonadotropin-releasing hormone analogs (GnRH analogs)
These drugs are very effective to reduce the size of Endometriosis implants besides relieve pain. They inhibit regulatory hormones secretion from pituitary gland and suppress estrogen production to stop menstruation. [4]
Figure 2: GnRH analogs available in Gluteal injection, www.drugs.com/pro/risperdal-consta.html
To ensure the success of the treatment, estrogen and progesterone are taken to avoid side effects. [4]
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Oral contraceptive pills
These are the most common combination of estrogen and progesterone in the form of (OCP) to treat Endometriosis. Women with severe menstrual pain need to take it continuously. [4] As a result, menstruation stops and this will free them from suffering the painful, distressing experience of Endometriosis.
Other drugs used to treat endometriosis:
Danazol (Danocrine)
It is a type of synthetic drug that produces a high androgen (male hormone) but low estrogen (female hormone). It is proven that 80% of women overcome the pain with reduction of the Endometriosis implants' size. [4] Moreover, it is commonly prescribed to reduce blood loss especially during menorrhagia. [26]
Women having liver, kidney, and heart problems are not recommended to take Danazol. [4]
Figure 3: Danazol effect, http://www.glowm.com/resources/glowm/graphics/figures/v5/0590/03.gif
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b) Surgical treatment
If medical treatments do not work, or Endometriosis is severe, surgery is the final choice. It is applied on condition where there is pelvic organs anatomic distortion, bowel or urinary tract obstruction. Surgery can be classified as conservative or definitive. The aim of conservative is to preserve the ovarian tissue and uterus, while definitive involve hysterectomy (uterus removal) with or without removable of both ovaries. [5]
Laparoscopy is done in conservative surgery by using laser to destroy Endometriosis deposits, remove ovarian cysts, divide adhesions, and excrete as little healthy tissue as possible. [6]
Surgery is very effective to reduce pain, but the success to improve sub fertility depends on the severity of the disease in the first place. There is 60% success rate of pregnancy for women with moderate Endometriosis, while only 35% chance for women with severe disease. [6][3]
Figure 4: Laparoscopy: Source: http://www.monlezun.com/endo8.jp
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Social and Economic Implications
Women suffering with Endometriosis commonly do not realize that they are having the disease until they are affected badly by it. For them, the pain is normal without seeing a physician for check up. Patients will find it difficult to do any activities during that period. Plus, their emotions are in unstable condition and this can lead to stress to the individual herself. [21] This might affect the relationship between the patients and the people around them. Besides that, loss of appetite will cause them to lose weight and cause their bodies
become weak due to lack of nutrition. In an article of Rapi Magazine, published on 15 April 2009, a patient named Nor Hasnilah said that the pain was intense and affected her badly until she even cannot go to work. The only thing she can do was lying on the bed and her responsibilities as a mother of two children and a wife were neglected. [21] Therefore supports from husband, family members and friends are vitally important for women dealing with Endometriosis.
Moreover, sometimes these patients are infertile. [5] Inability of getting a child will cause the patient to be in a great distress especially for couples who have been married for several years. Taking medications in which the side effects are sometimes difficult to tolerate will be an obstacle for them and consequently cause the patient to lose hope. They may feel embarrassed and lack of confidence when facing people or frustrated by lack of energy. This could lead to serious social impact and worries to people around them.
In addition, the cost depends on the type of treatments chosen. Selected treatments such as using the newer drugs like GnRH agonist and surgery are more expensive. The cost of surgery depends on patient's locale and the extent of his/her surgery. In the U.S, typical outpatient laparoscopy is very costly, usually in the range of $12,000 to $15,000. It could be double if extensive surgery is done and the patient is admitted for a few days. [11] Hence, it would cause huge financial burden and major economic impact to the family.
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Benefits and Risks
NSAIDs are really effective to relieve pain and do not need other medications if they do work. However, frequent used of these drugs will promote the development of ulcers and Gastrointestinal tract bleeding. Such effects could be monitored carefully by physicians since the drugs were being administered under them. [27]
GnRH analogs and Aromatase inhibitors work effectively to relieve pain and shrink the size of Endometriosis implants. Lack of estrogen production due to these drugs will cause osteoporosis, fatigue, mood changes, and vaginal dryness. Usually physician will give pill containing small amount of estrogen and progesterone to avoid most of the side effects. [4] Enough calcium intakes also are needed to prevent osteoporosis.
Drug like OCP helps to relieve pain by suppressing estrogen formation and stop menstruation. Weight gain, breast tenderness, depression, and irregular uterine bleeding are some of the risks. [4] Patients are advised to take balance diet to get enough nutrients and exercise regularly to avoid weight gain and to reduce stress. Breast tenderness and irregular bleeding are only mild side effects. So patients should be carefully monitored by physician to avoid even severe effects.
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Statistics shows that 75% women develop side effects after taking Danazol .[4] The risks are:
Figure 5: Source: http://images.rxlist.com/images/rxlist/synarel-endo2.gif
However the changes are reversible. Danazol works effectively to relieve pain and reduce the size of Endometriosis implants. [4] Hirsutism can be treated by local removal of unwanted hair[29] while practicing healthy lifestyle such as exercise and proper intakes of nutrients can overcome other problems.
Basically all of medications have their own benefits and risks. The chance for Endometriosis to recur after surgery can be as high as 40%.[5] Careful observation by physician is needed although the implants have been removed. It is vital to educate and motivate patients about the risks.
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Alternative Solutions
Acupuncture and Herbals Treatments
Herbal medicine uses medicinal plants applied internally and externally to cure disease. Herbs work by enhancing the body's immune system with natural approach. The usage of herbs with modern treatment boosts the effectiveness to treat Endometriosis. [9]
Combination of herbal formulas and acupuncture points are chosen according to the individual's Traditional Chinese Medicine diagnosis and different for each person. Some common acupuncture points for Endometriosis treatment can be located on ears, abdomen, wrists, feet, and legs by using needles for 20 to 45 minutes. [9]
These combinations help to facilitate the free flow of energy through the body besides help to smooth blood flow, break up stagnation and stop pain. Each point and herb chosen has its own therapeutic importance in Endometriosis treatment. [9]
"Great for bowel related pain I have found that chinese herbs and acupuncture help enormously in stabilising the bowel, and thus reducing pain (along with a dairy free diet)."
Posted over 6 years ago (10/24/03)
Source: http://www.revolutionhealth.com/drugs-treatments/rating/acupuncture-for-endometriosis
Naturopathy
It is also known as 'natural medicine' (the power of body to heal itself). It requires 6-12 months period of treatment depending on the severity and duration of the condition [25]. It is a holistic approach since endometriosis program in Naturopathy considers the patient's diet, lifestyle, cleansing and hormone balancing herbs, including pain relief's herbs and external preparations to clear toxicity in abdominal area. Furthermore, instructions for gentle exercise program are also included.[9]
This treatment will success if dietary and lifestyle changes are followed strictly by the patients to prevent reoccurrences. Combination of diet and non-invasive therapies are conducted to enhance healing process. [9]
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Aromatherapy
Aromatherapy uses the natural aromatic aspects of plants into essential oils; extracted from the seeds, barks, leaves and roots. It operates both through the sense of smell and within the body. [9]
Figure 6: Parts of plants used, http://www.frienvis.nic.in/Bulletinwork/26.jpg
Massage oil is prepared with essential oils before rubbed on the skin. The essential oils work by absorbing through the cell tissue and into the bloodstream throughout the body. Organs and body systems interact directly with these oils through massage done by the aroma therapist. [9]
Moreover for Endometriosis treatment, different essential oils with different chemical composition properties used can develop healthy digestion, prevent insomnia, boost immune system, support reproductive system, and rebalance hormone system. [9] Thus, it is proven to overcome residual effects of Endometriosis.
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Evaluation
Medical treatments by using different types of drugs have been found to treat Endometriosis effectively by suppressing estrogen production pain and shrink the Endometriosis implants from reference http://www.medicinenet.com/endometriosis/page4.htm. This source is reliable since it also agrees with many other sources. One of them is http://www.endo-resolved.com/treatment.html which states, "Danazol - is a mild form of the male hormone testosterone and reduces the amount of estrogen produced by the ovaries to around the same level as during menopause". Both of these sources are reliable since they provide in-depth information, support and education related to Endometriosis. Moreover, these websites contain lots of review articles and researches on Endometriosis. The web Endo Resolved is managed and written by Carolyn Levett, a Registered Integrative Humanistic Counsellor, writer and also a qualified Supervisor and Group Therapist [14]. Thus, she must be very familiar with the disease through extensive research, experienced from her clients and reading on Endometriosis.
I also found the book entitled 'New Guide to Medicines & Drugs' which mentioned "excessive blood loss (menorrhagia), pain during menstruation (dysmenorrhoea), and distressing physical and psychological symptoms occurring prior to menstruation require medical treatments". This source also agrees to the source 'Handbook of Pharmacy Health-Care' which states "the symptoms of endometriosis are varied, but usually include dysmenorrhea, dyspareunia, menorrhagia, instermenstrual pelvic pain, and back pain"; a brief explanation. Both of these sources are trusted since the first book mentioned was edited by Professor John A. Henry and approved by the British Medical Association while the second book emphasises information about the treatments published by The Pharmaceutical Press, undoubted sources.
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