While a range of treatments for endometriosis exists, there are limitations on their effectiveness: drug therapy carries a dependency on continuous usage; and there are risks of surgery with a 40 per cent probability that this invasive handling would not work.
This leaves most women who live with this condition with some semblance of its monthly painful symptoms until menopause when menstrual cycles are ended.
Endometriosis is a monthly agony that comes on before or during the period but is much more painful and devastating to the extent that it renders some women incapable of doing any useful work at that time. While medical science is still unsure of the cause of endometriosis, what is known is that it never goes away because any successful medication must be taken until menopause, and treatment bears risks for those of childbearing age who wish to have or continue having children.
“This thing is incurable. This thing is devastating,” declared University of the West Indies Lecturer, Dr Damian Best.
Delivering a lecture themed Painful Period: Could It Be Endometriosis, the Consultant Obstetrician and Gynaecologist and British Fertility Society Certified Lecturer Specialist, explained that the cause of endometriosis remains a mystery – “that’s the million-dollar question” – but this most painful of pain periods is hormone-triggered and ‘wreaks havoc’ on women’s bodies.
Last week, our column sought to explain what is endometriosis, based on Dr Best’s presentation. Today, we will look at some available treatments for persons living with endometriosis, stemming from explanations of the doctor.
Signs and symptoms of endometriosis include pain; pain with periods; vomiting; and headaches, all of which are so extreme that they cause disruptions in the life of women. They may also be having problems getting pregnant.
“You could treat for Dysmenorrhoea proper – generally painful period that is not endometriosis – as a therapeutic treatment. You never know, it might get better, and some people might not need to get a diagnostic procedure because the treatment works,” Dr Best said, explaining that these are the lucky ones who are not endometriosis sufferers.
But, he said, it takes an average of 7.5 years to make a definitive diagnosis of endometriosis because “women hide their symptoms very often. They’re ashamed to come to us and say, ‘I’ve been having these painful periods’”.
Another reason for the long average time is because some sufferers might be reluctant to come forward for the surgery for a proper diagnosis and prefer other therapeutic trials before eventually agreeing to an exploratory operation.
That operation is laparoscopy, which Dr Best describes as ‘the gold standard’ in diagnosis. “What is laparoscopy? Basically surgery under general aesthetic,” he said, explaining that doctors have a look with a camera for typical deposits of endometrial tissue, the linen-like tissue that is the cause of endometriosis, and which can be found in any area of a woman’s body though it is usually in or around the womb.
Endometriosis is classified in stages of minimal, mild, moderate, and severe but the stage does not always equate with the symptoms.
“So, you can have mild endometriosis… with terrible pain and can’t get pregnant for nothing. And you could have [the severe stage] and have no pain at all.”
Dr Best said that ideally, treatment calls for a multi-disciplinary approach involving doctors, nurses that are trained, physiotherapists, pain management specialists, and fertility specialists, “All with the aim of helping that person achieve their therapeutic goals with endometriosis. We’ve got a way to go [towards] meeting that goal in Barbados unfortunately, but we’ve got support groups.”
He said that non-anti-inflammatory drugs such ibuprofen, “tend to be preferred because it has less stomach upset and works very well”. But the evidence shows it is good for younger persons with early pain symptoms rather than sufferers with full blown endometriosis.
There is hormone treatment, but here issues of fighting the pain of endometriosis are separated from battling pain of endometriosis and pregnancy. “Anytime you’re introducing hormones to relieve the pain… we’re preventing pregnancy,” said Dr Best who described this treatment as ‘contracepting’. “So, if your true aim is pain relief, you probably have to forget about getting pregnant for the time being, if you want to use hormones. “If you’re trying for pregnancy, then you leave hormones out.”
Those who chose to simply fight the pain regardless do not get away free because if “you stop those medications, the symptoms are going to come back. You might have some pain-free lag but the symptoms tend to come back [when] you stop the medication”.
There is a once-a-month treatment by injection that puts a sufferer temporarily into menopause stopping the period.
“Remember, endometriosis needs oestrogen to feed off of so you’re stopping the period, blocking the oestrogen from coming, so you’re relieving the pain,” he said.
There is the option of removing or destroying endometrial deposits through surgery. The doctor warns however, “You usually need to tell and counsel the woman carefully before operating on her to remove endometriosis [because the] average improvement is 60 per cent, which means some people are still going to have symptoms despite best efforts, though the majority would have improvement.” He said that after surgery “symptom recurrence can occur in up to 13 per cent, a little more than one in 10”.
Some women tend to have endometriosis pre-symptoms as teenagers, and Dr Best said, “It is best not to operate on those women considering they’re just turning their reproductive age. And the earlier you go [for surgery], the more likely it is that endometriosis comes back, and she needs some more surgery”.