Treatments for endometriosis pain

Q: I’m only 20 years old and have suffered quite a bit of pain due to confirmed endometriosis. I have tried both Procera and Duphaston and neither has worked for me. So far the most effective treatment is when my fiancé rubs the problem area (my lower back) for me! Can you offer any other treatment suggestions?

A: The easiest way to understand endometriosis is to imagine your menstrual flow – the lining of your uterus – backing up and flowing in a retrograde manner back up your fallopian tubes, instead of out of the cervix. Then imagine this tissue implanting itself on different pelvic organs. After this occurs, the tissue acts like regular uterine tissue; it bleeds and produces chemicals that stimulate menstrual cramps.

One easy way to treat the pain is to block some of these chemicals, called prostaglandins. Ibuprofen and naproxyn (Motrin and Aleve) block the making of prostaglandins, so you need to take them early, when you start to get uncomfortable. Don’t wait until you’re miserable to take them.

Your physician has given you progesterone, one of the oldest hormonal therapies designed to suppress these tissues. Birth control pills are often much more effective. And if you have a lot of money (or good insurance coverage), you could try a drug called Lupron. Lupron is referred to as a gonadotropin agonist, and basically produces a temporary chemically induced menopause. It comes in injection form, given every one to three months. It actually causes the endometriosis to shrink, whereas medications like ibuprofen just relieve pain. It is expensive per month, and a standard course of this medicine lasts three to six months. But you may well get long lasting relief, and possibly a cure. Similarly, if you are ready to have a baby, the hormones of pregnancy will also suppress endometriosis.

Surgical intervention can also be helpful in treating endometriosis. Operating through a laparascope (a long tube with a fiberoptic light), through an incision the width of your thumb, gynecologists can often cauterize endometriosis and reduce scar tissue. You should discuss all of these options with your caregiver, to try to find out which would be best for you.

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