Treating endometriosis
ALL this month, we have heard stories about women living with endometriosis, as well as the myths and the symptoms or complications associated with the disease. Thanks to modern medicine, however, there are many options for treatment and relief of problematic symptoms. The key is for women to recognise abnormal symptoms and seek prompt treatment by a gynaecologist. The treatment used depends on the patient’s symptoms and fertility concerns.
Pain
Pain can be treated with painkillers, ranging from over-the-counter medication to stronger prescription meds. Hormonal therapy is also often used, starting with simple hormonal contraceptives. In more severe cases, it may be necessary to use stronger medication to suppress the hormone production from the ovaries that ‘feed’ the endometriosis (this puts the patient into a menopause-like state and so is only used for a few months’ duration). If pain is severe, interfering with normal activity, or unresponsive to medication, then surgery may be needed to remove internal scarring caused by the endometriosis. If the scar removal surgery does not resolve the pain, then more treatment options such as surgically implanted pelvic nerve modulators, neuropathic pain medication, or even surgery to remove the uterus and ovaries might have to be done. Surgical removal of the reproductive organs is a big step to take, and is only done in extreme cases after adequate counselling.
Bleeding
Abnormal (usually heavy) bleeding may also be associated with endometriosis. This is usually treated initially with medication, which may be hormonal or non-hormonal. The hormonal methods may be given in the form of pills, patches, vaginal rings or implants into the skin or uterus. The non-hormonal methods are usually in pill form, and some may have the dual effect of controlling bleeding as well as pain. Severe bleeding that is not responsive to medication may require surgery, which can range from minimally invasive, using special scopes in the uterus, to more major pelvic surgery. Pelvic surgery can involve removing sections of endometriosis out of the muscle wall of the uterus or removing the entire uterus, depending on the patient’s fertility desires.
Infertility
Infertility in endometriosis can be caused by a multitude of factors. Sometimes it is due to damage to the patient’s tubes. In those cases, tubal repair can be attempted using laparoscopic (minimally invasive) surgery. If tubal repair is not possible, or if infertility is not due to visible tubal damage, then patients will need assisted reproduction, which includes in-vitro fertilisation (test-tube pregnancy). This process is very expensive financially and emotionally, and requires proper counselling before starting any procedures. It typically involves giving the patient medication to allow her to ovulate, and then have the mature eggs removed under ultrasound guidance in a special clinic. The egg is then mixed with her partner’s sperm and the fertilised embryo is re-implanted in her uterus to allow pregnancy to occur. If egg or sperm quality is an issue, then donor eggs or sperm have to be used. These procedures are available in Jamaica at the Hugh Wynter Fertility Management Unit of the University Hospital.
Occasionally, assisted reproduction will not be possible or will fail multiple times, making it impossible for a patient to carry her own pregnancy. In cases like this, surrogacy (where another person carries the pregnancy with the patient’s embryo), or adoption can be considered. These both have many legal procedures and processes, which should be clearly outlined at the outset under proper legal guidance.
Endometriosis often involves a large emotional and social toll on patients and their partners or families; however, no one should suffer in silence as there are many options for treatment.
Dr Anna-Kay Taylor Christmas is a consultant obstetrician and gynaecologist at the Obs and Gynae Centre, Winchester Business Centre. She can be contacted at drtaylorchristmas@gmail.com or 908-3263, 906-2265, 325-7362.
