Endometriosis is a chronic and often painful condition where tissue similar to the uterine lining grows outside the uterus. It can cause debilitating symptoms and complications, including infertility. Here’s an updated overview of endometriosis, its impact, and the latest treatments, including recently approved medications.
What Is Endometriosis?
- Symptoms: Common symptoms include painful periods (dysmenorrhea), pain during sex (dyspareunia), lower abdominal or pelvic pain, and vague pelvic complaints.
- Infertility: Endometriosis is a significant cause of infertility:
- About 50% of infertile women are found to have endometriosis.
- Approximately 50% of women with endometriosis experience infertility.
While the exact link between endometriosis and infertility is not fully understood, inflammation and scarring caused by the condition may disrupt normal reproductive processes.
Why Treatment Matters
- Endometriosis is a progressive disease, with 30-60% of patients experiencing worsening symptoms or lesions without treatment.
- Early intervention can manage pain, improve quality of life, and address fertility concerns.
Treatment options vary based on symptom severity, disease progression, and fertility goals.
Current Treatment Options
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Surgical Management:
- Laparoscopic surgery is the gold standard for diagnosis and treatment of endometriosis.
- Surgery can remove lesions, reduce pain, and improve fertility in some cases.
- Studies suggest surgery may result in faster conception times compared to medication alone.
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Hormonal Medications:
- Hormonal therapies reduce estrogen levels, which fuel endometriosis growth.
- Lupron (leuprolide acetate):
- A GnRH agonist that drastically lowers estrogen levels.
- Can reduce pain and shrink endometrial lesions but may cause menopausal-like side effects (e.g., hot flashes, bone loss).
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Lifestyle Adjustments:
- Anti-inflammatory diets, regular exercise, and stress management may help alleviate symptoms.
Newer Treatments for Endometriosis
1. Orilissa (Elagolix)
- Approved in 2018, Orilissa is a GnRH antagonist that suppresses luteinizing hormone (LH) and follicle-stimulating hormone (FSH), leading to decreased estrogen and progesterone levels.
- Dosage Options:
- 150 mg once daily (QD) for up to 24 months.
- 200 mg twice daily (BID) for up to 6 months.
- Who Should Avoid It?:
- Pregnant individuals.
- Those with osteoporosis (due to potential bone loss).
- Side Effects:
- Hot flushes, night sweats, headache, nausea, insomnia, amenorrhea, mood changes, and joint pain.
- Considerations:
- Estrogen-containing contraceptives may be less effective when taken with Orilissa.
- A warning exists for potential mood disorders and suicidal ideation.
2. Myfembree
- Approved in 2021, Myfembree combines relugolix (a GnRH antagonist), estradiol, and norethindrone acetate.
- Benefits:
- Reduces pain while minimizing bone density loss compared to other GnRH therapies.
- Dosage:
- A single tablet taken once daily.
- Side Effects:
- Similar to Orilissa, with fewer menopausal-like symptoms due to the inclusion of hormone add-back therapy.
Fertility Considerations
For women with endometriosis who wish to conceive, a personalized approach is essential:
- Surgical Treatment: Removing lesions and adhesions can improve fertility in certain cases.
- Fertility Assistance:
- Ovulation induction and intrauterine insemination (IUI) for mild cases.
- In vitro fertilization (IVF) for advanced disease or severe infertility.
When to Seek Help
If you experience symptoms such as painful periods, painful intercourse, or difficulty conceiving, it’s time to consult a specialist. Early diagnosis and a tailored treatment plan can significantly improve outcomes.
Take Control of Your Endometriosis
At Women’s Health Practice, we offer personalized care, including access to clinical research trials and the latest treatment options. Schedule a consultation to discuss your symptoms, fertility goals, and the best treatment plan for you.
Additional Resources:
- Endometriosis Information – Mayo Clinic
- Orilissa Prescribing Information
- Myfembree Prescribing Information
Together, we can manage your endometriosis and help you achieve your health and fertility goals.
