Treating Endometriosis

Endometriosis impacts women and adolescents’ quality of life, sexual pleasure, and ability to have children.  The founders of EFA strongly believe that specialized surgery called “Laparoscopic Excision” is the gold standard of endometriosis treatment.

1. Laparoscopic Excision Surgery
Laparoscopic Excision: Laparoscopic excision removes all forms of the disease, restores normal organ placement and function, and treats pelvic pain and infertility. With laparoscopic excision, patients can expect a great deal of their symptoms to disappear or be greatly reduced. In most cases, even in higher stages, excision surgery can successfully resolve infertility as well. Laparoscopic excision involves finding and excising, or cutting out, all forms of endometriosis. Currently only a small number of advanced gynecologic surgeons perform this life-changing operation, including EFA’s Founder, Dr. Tamer Seckin, MD.


2. Other Laparoscopic Surgeries
Other Laparoscopic Surgery:Other surgical techniques exist, including surgical ablation, cauterization, fulguration or vaporization through the laparoscope. These types of laparoscopic surgeries involve the removal of endometriosis on the surface of different tissues and organs in the pelvic region but do not go as deeply into tissue as laparoscopic excision. These kinds of incomplete removal may offer temporary relief of endometriosis, though studies have placed recurrence rates at 40-60% within the very first year following these types of surgery.


3. Hysterectomy
Hysterectomy:While removal of the uterus has a role in endometriosis treatment, it should never be considered a cure. Removal of the uterus and in some cases, the tubes and ovaries may be helpful in limited circumstances, such as in those who have largely invasive disease that may have resulted in “frozen pelvis.” Each case for hysterectomy should be very carefully evaluated and should also include meticulous excision of all disease at the time of the procedure.


4. Hormonal Treatments
Hormonal Treatments :Studies have shown that endometrial tissue outside the uterus responds to hormones like endometrial tissue inside the uterus. This means the tissue grows, swells, and sheds during the menstrual cycle. Popular medical treatments have largely been designed to stop menstruation and mimic menopause.

Contraceptive-Based Hormonal Treatments

Three common types of hormonal contraception – Depo-Provera®, Mirena®, and oral contraceptive pills can be used to treat endometriosis.

Continuous Oral Contraceptives: Taking oral contraceptive pills without any breaks may be a good treatment for women and girls with the disease who continue to experience painful periods when they use oral contraceptive pills the “normal” way in which they have a cycle at the end of every four week pack. Taking oral contraceptive pills continuously suppresses menstruation and as a result may relieve many symptoms of endometriosis. Some women find the side effects of oral contraceptives (i.e. weight gain, depression, or headaches) to be problematic. Symptoms of endometriosis will recur when women stop taking the pills.

Depo Provera® can be used to create levels of the hormone progesterone to resemble a woman’s hormones in early pregnancy. This stops ovulation and menstrual periods in most women and may help some women or girls with temporary relief from endometriosis symptoms. But some women and girls find Depo Provera’s® side effects to be problematic. Symptoms of endometriosis will recur when the drug therapy is stopped.

The Mirena® coil is another progestin therapy. Mirena® is a small, plastic T-shaped intrauterine device (IUD) that can be used for up to five years. Little information is available on the use of Mirena for women with endometriosis and its use is largely anecdotal. The Mirena® IUD is a relatively new option for women and girls with the disease and only limited studies about effectiveness, potential side effects and long-term outcomes have been done.

Other Hormone Therapies

GnRH-As: Lupron®, Zoladex®, Synarel® and Suprefact® are common GnRH-A (gonadatropin releasing hormone agonist) drugs. These drugs are designed to cause a patient to stop ovulating or menstruating; making a condition similar to that of menopause. GnRH-As are intended to suppress the symptoms of endometriosis temporarily. Indeed, rates of recurrence in the first year following therapy may be as high as 74.4%. GnRH-As may also have significantly negative – and long-lasting – side effects ranging from bone density loss to impaired memory function, among others.

Aromatase Inhibitors: Similar to GnRH-A therapy, Aromatase Inhibitors (such as Letrozole®) are a relatively new class of drugs designed to temporarily suppress estrogen levels. They are intended for short-term relief of symptoms only. Side effects are expected to be similar to those experienced with Lupron and other GnRH-A drugs, and recurrence of endometriosis in the long-term has not been adequately studied.

Contraceptive-Based Hormonal Treatments
Other Hormonal Treatments

1. Pain Killers
Painkillers: Pain killers like aspirin or ibuprofen as well as non-steroidal anti-inflammatory drugs and prescription narcotics such as Vicodin® may help reduce – but not remove – some of the symptoms associated with the disease. Long-term use of painkillers can have many side effects.


2. Diet and Nutrition
Diet & Nutrition: Some women find they may be able to effectively reduce and even control their symptoms through changes in diet. Anecdotally, there is evidence that diets that promote anti-inflammatory, healing properties can promote hormonal balance and reduce symptoms. The dietary approach can also address the Candida (yeast) and food allergy concerns that many women with endometriosis experience. While no single diet or food approach will work for all women and girls with the disease, it is a non-invasive means of improving overall health. A wonderful resource on this topic for further reading is “Endometriosis: a Key to Healing through Nutrition” by Dian Shepperson Mills, MA and Michael Vernon, PhD, HCLD.


3. Alternative Therapies
Alternative Therapies: Alternative therapies include many very different methods. Some of the most popular therapies reported by the endometriosis community include herbal medicines, acupuncture and various kinds of massage, exercise, biofeedback therapy, transcutaneous electrical nerve stimulation (TENS), and other homeopathic and naturopathic therapies.