Treatments Can Ease Endometriosis : Medicine: Surgical techniques and advances in hormone therapy can help women with this painful disease.

Endometriosis affects about 15% of women of reproductive age. Women with this condition experience chronic pelvic pain, and many experience years of frustration in a search for a diagnosis. But advancements in surgical techniques and new studies have given doctors additional methods of diagnosis and treatment.

Donna, 30, went through 15 years of chronic pain and a series of doctors before her condition was diagnosed.

“A lot of doctors still tell women, ‘You have cramps; you have to live with it,’ ” says Donna, who asked that her last name not be used. But “any time there is that much pain, there has to be (another) cause.”

Testing eventually showed that she had an ovarian cyst and internal scarring because of severe endometriosis. She underwent abdominal surgery to remove adhesions and endometrial implants, which are cells that are similar to the uterine lining that respond to the hormones that govern the menstrual cycle.

When her symptoms returned a few months later, she received another referral. She underwent laparoscopic surgery, which uses a laser to remove the implants, which can often return. She is also being treated with hormonal therapy.

Her pain has lessened, Donna says, and she is getting help in living with the disease. Still, she may have to have more surgery.

“It’s hard to live with. You get down sometimes,” she says. “But they’re coming out with new things every day. I’m still holding hope that some new procedure will come along” that will cure the condition for good.

Despite the severity of the disease, said Dr. Deborah Metzger, co-director of the University of Connecticut’s Endometriosis Treatment Center, there is good news in the available treatments.

“Every woman’s endometriosis is different, and every woman has different priorities and goals in her life,” Metzger says. In terms of treatment, “there has to be some mesh between the two. When working with a woman, we go through pros and cons of each option. At this point, endometriosis is still something that cannot be cured but can be managed. We have many more tools for treating the pain.”

One is laparoscopic surgery, in which a lighted tube is inserted in the navel through a small incision.

Laparoscopy is also used to perform vaginal hysterectomies, in place of conventional abdominal surgery. Metzger says patients have a much shorter convalescence and quicker recovery after laparoscopic surgery. Removal of endometrial implants through laser surgery can enhance fertility and control the disease without removal of reproductive organs if the woman does not wish to have a hysterectomy.

Hormone therapy is also available. In many cases the hormones are combined to achieve the desired effect.

Progestin, a synthetic form of progesterone, prevents ovulation and suppresses growth of the endometrium and the implants. The drug Danazol stops stimulation of pituitary hormones, in effect stopping the menstrual cycle.

Hormones called GnRH agonists, which are prescribed for six months, also affect hormone production in the pituitary gland, which in turn stops hormone production in the ovaries, producing a temporary state of menopause. (The condition is reversed when the drug is stopped.)

Metzger says that a combination of these treatments can, in many cases, provide long-term relief for women with endometriosis.

About 60% of women seeking treatment for infertility are found to have endometriosis, she says. “Very often women with infertility have endometriosis that doesn’t cause any symptoms and discover they have it when they seek treatment for infertility,” she says.

(The major symptoms of the disease are severe cramps that get worse over time, pain with intercourse, pelvic pain during the menstrual cycle or at other times and infertility.)

“Some women can have no symptoms at all and have horrible endometriosis, and others can have devastating pain and a small amount of the disease. The degree of symptoms does not correlate with the amount of the disease,” Metzger adds.

The cause of endometriosis is not known, but Metzger says that researchers believe it is caused by retrograde menstruation, or menstrual blood that flows backward and out through the Fallopian tubes. Scarring or adhesions from endometriosis cause internal tissue to bind the pelvic organs together.