Guest Author - Dr. Denise Howard
Endometriosis is a chronic condition, which can produce pelvic pain, infertility and painful intercourse. Its course is unpredictable however recurrence and progression occurs in over 60% requiring long-term treatment in many. Many hormonal type medications are utilized in the initial and long-term management of endometriosis. Having a wide range of choices is important since it allows the physician to tailor the treatment to individual needs, risks and preferences. In addition it provides options if one method is ineffective.
Analgesic medications are initially used in the treatment of menstrual related pain. This pain maybe the first indication of the development of endometriosis. Pain limited to the time of menstrual period is referred to as dysmenorrhea. Traditional non-steroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Advil), naproxen (Aleve), mefenamic acid (Ponstan) and diclofenac (Voltaren) is extremely effective in addressing dysmenorrhea. Side effects and medication complication is usually minimal if the use is limited to no more than 5 days per month. A new brand of NSAIDs includes the Cox-2 inhibitors, which block the production of prostaglandins, the cause of menstrual related pain. The drugs include celecoxib (Celebrex), rofecoxib (Vioxx) and valdecoxib (Bextra). The benefit of this new class of drugs is less gastrointestinal side effects.
At the point that analgesics are no longer working, then hormonal therapy should be considered if there arenít any contraindications. Combination hormonal contraception is the simplest and most effective therapy in menstrual related problems. This therapy significantly reduces both the pain and the blood loss due to menstruation. In addition it can suppress endometrial tissue growing at other sites (endometriosis). The pill comes in the traditional 21day use with 7 pill free days in which the menses will occur. There are numerous brands available on the market. The medication can also be delivered through a skin patch or intracavitary ring. More recent productions are 24 day use with 4 pill free days, which minimizes minor pill related side effects. The most familiar brands are Loestrin 24-FE and Yaz. Finally, standard birth control pills can be manipulated so that menses occur 3-4 times a year or not at all. There are specific brands designed so the user can have a period 4 times a year (Seasonale or Seasonique) or not at all (Lybrel).
Progestin only medications are also a mainstay in the treatment of endometriosis. They have been shown to reduce the endometriosis related pain by 80%. The pill formulations include medroxyprogesterone (Provera) 10 mg three times a day or norethindrone acetate up to 15 mg per day. Any mini-pill or progestin only contraceptive pill can also be used. A newer progestin dienogest (Visanne) 2 mg daily has been specifically designed to treat endometriosis.
Progestin only treatment also comes in other delivery options. The injection, called Depo-provera can be given every 12 weeks at a dose of 104 or 150 mg. There is an etonogestrel subdermal implant called Implanon, which is effective for 2 years and the levonorgestrel intrauterine contraceptive device, which is effective for 5 years. Each has its own specific side effect but the overall effectiveness is high for all methods.
The majority of these medications are not specifically indicated for the management of endometriosis but their mechanisms of action make them ideal for the treatment of this menstrual related disorder. Having a broad range of choices allows for tailoring of treatment regimens to meet the needs and desires of individuals. If you suffer from endometriosis you should work closely with your gynecologist to develop a treatment plan that works for you.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!