Are there any new treatments for endometriosis?

There are myths of treatment of endometriosis. What we used to do as gynaecologists, if we suspected endometriosis, we would start with painkillers – non-steroidal ibuprofen medications or any non-steroidal medication if it’s mild endometriosis and this painkiller can just increase and accelerate, start to be opiates, morphia or now the research on cannabinoids medication because of the oils, there are some theories that it can suppress the endometriosis but the only problem with this is the side effect: increasing the bloating, increasing the bowel symptoms and it could be very devastating when you stop it -you have the symptoms again. So, it’s not just a real treatment where it can cure you.

The second line of treatment is medical treatment and medical hormone. Basically you can take hormone pills, oral contraceptive pills for a longer time and this is something behind the delayed diagnosis of endometriosis because many women in the reproductive age, they are taking hormone pills even before they are starting their family and these hormone pills will mask the symptoms of endometriosis and prevent the pregnancy. Once you stop these hormone pills, we’ll start to see the flare-up of the symptoms and unfortunately, very recent study published on November 21st (from the United States) on hundred thousand ladies, they found that all hormone pills can affect the ovarian reserve – I mean your storage of eggs inside the follicles by time -as long as you will take this medication. The difference is between 5 % to 55 % below the average population that are not taking hormone pills. So, if we are thinking about that in the longer term, hormonal pills will not treat, they just calm down the storm and it will not treat. Sometimes, if the pain or the symptoms are very severe, we can give some medication called GnRH analogues (it’s the gonadotropin releasing hormone). Simply this hormone will work on the pituitary gland (the maestro gland) and this gland will just stop secreting the hormones from your ovary with time you are taking this medication but its effect is very devastating because you may feel many possible symptoms, that you should feel it at 50, while you are still very young. So, it’s something very weird and you will pay for that over the long term. After more than six months, you will start to feel bone ache, hot flushes and every devastating symptom you will not want to feel while you are very young. So, this is a kind of hormone treatment we can give.

Another line of treatment is surgery and it’s the pros and cons of surgery because surgery itself is a very complicated procedure for endometriosis. It’s not that easy surgery. We can go into your tummy and find that everything is just adherent and we will treat it – will remove these adhesions and as well we remove the nodules – especially of deep endometriosis surgery. If we can imagine this is the lumen of the rectum sometimes endometriosis could be here, we can do shaving of rectum for it or sometimes it could be implanted here and we need to just remove all this section, remove it all and do the section anastomosis for this part and upper part – we remove this part out. So, it can be very fast, very required in case of deep endometriosis surgery but what I will suggest, this surgery has its drawbacks because it definitely can affect fertility. So, if you are looking for fertility – it’s another story, if you just want to have this treatment – it’s another story. If you just need to do the surgery – do it – but will the surgery prevent this disease from coming back – nobody knows because we have done this surgery one time and then after one year same thing, another time and three times. So, I remember in 2012, we just kept repeating, doing this operation and nobody explain – why it’s coming back because it’s not treating.

One more point about treating endometriosis and you should treat the other symptoms which are the symptoms in the background noise which is chronic pelvic pain – it may be very beneficial to deal with pain therapists. It may be very beneficial to speak with a cognitive behavioural therapist in your place and they have many many things to help you with. Acupuncture can help with this pain in the long term. How you speak to yourself about this pain – is very helpful. Even before doing the surgery, I will advise you to start to try this cognitive behavioural therapy and after the surgery will be much easier because it will just treat any remaining from this dysfunctional problem in your body. Sometimes you may benefit from doing other surgeries like cystoscopy to examine the bladder if there is any endometriotic nodule there or not. So, this will be also helpful to diagnose and to start to look for this area about pelvic floor muscle exercise – if you have any symptoms related to bladder pain syndrome. So, take it as a whole – you should ask your specialist and they will inform you about exactly what to do before even starting to have the surgery otherwise, you will fall victim to repeated surgeries every now and then.

We have a tablet called dienogest which is becoming a game changer in the treatment of endometriosis so, dienogest is not approved in every country yet but slowly the acceptance is rising very very massively and fast and it should. I hope it is available in most of the countries in the coming few years and dienogest it’s a type of progesterone very specific for the endometriosis pain and this tablet can be started for the younger age group because it is not a typical and also because it it is only progesterone and we always try to either not give estrogen or give a very low low estrogen to keep women safe against other side effects. These days there is new technique called donnez technique which is getting very popular how to do the surgery so, rather than doing the whole cyst stripping, they cut the that cap the top and then they filgrate the base keeping the ovarian reserve intact as much as possible so, very very minimal, very gentle surgery.