THE ENDO CLUB...Please Pray for Us!

LUPRON: Please read all the facts about this drug. I believe we must be aware, as I have never heard any of this stuff from my Gyno's and I have read that most others have not also.
http://health.groups.yahoo.com/group/LupronVictims/
http://www.geocities.com/lupronfacts
http://www.endocenter.org/lupron.htm
http://www.mercola.com/2002/mar/6/lupron.htm
You can also put in a search on the link below to talk to real women who have used this drug-good & bad stories.
http://forums.obgyn.net/endo/
also see my forum to talk to past users.

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Treatment for Endometriosis is an intensely debated subject. One of the key problems is that no-one really knows what causes Endometriosis. So trying to find successful treatment for this particular health problem is like trying to fix something even though the cause is not actually known. This can lead to treatment methods which are not relevant or safe. Until a concise answer is found to the cause of Endometriosis, then the treatment being offered is no more than a stab in the dark.

There is much research underway around the world today, with huge amounts of money being invested, looking at ways to treat Endometriosis. But if as much money was spent looking at how the disease starts in the first place, then developing treatment that leads to a cure will be much more focused, meaningful and successful. The key problem here is economics and the relationship between pharmaceutical companies and research funding.

The treatment for Endometriosis being offered by conventional modern medicine today depends on the severity of the disease that a woman has. The main thrust of treatment is to help alleviate the symptoms. There is no treatment being offered which is aimed at ridding women of this disease, but only to offer some respite.

There are general points which should be taken into consideration when helping a woman decide which treatment option to go for. These should include:

• The severity of the symptoms
• The type of symptoms
• The age of the patient
• The desire to get pregnant or not
• Length of treatment
• Coping with side-effects of drug treatment
• Cost (in countries where women have to pay for treatment)
  
  How does the treatment work

Endometriosis is fed by estrogen. Estrogen is the hormone that is produced in a woman’s body continuously, but each month there is a surge of this hormone which causes the uterine lining to thicken to prepare for pregnancy. Then the estrogen levels drop and if there is no fertilisation of the egg that month, the lining of the uterus is shed and a woman has her period.

The aim of some treatments is to reduce or stop the estrogen being produced in a woman’s body, so that it does not continue to feed the Endometriosis growths. This is achieved by hormone drug therapy. This type of treatment is only successful for milder cases of Endometriosis where the growths are relatively small and few in number. In more severe cases then treatment with surgery is usually needed to remove the growths.

You may find many different references and names for the growths relating to Endometriosis. They can be called cysts, lesions, endometrial tissue, endometrial cells, as well as endometrial implants. These different terms are sometimes used to define different stages of the disease.

Treatment options

The options for which treatment to have are usually dependent on the extent of the disease. The treatment options for Endometriosis include:

• Observation with no medical intervention
• Hormone treatment
• Surgery
• Combined treatment

This approach can be used for milder cases of Endometriosis, with regular visits to your doctor or gynaecologist to monitor your health. Analgesics may be prescribed to help with any pain, and nonsteroidal anti-inflammatory drugs can help.

Treatment of endometriosis with hormone drugs can result in temporary improvement of symptoms such as painful periods, pain on intercourse and pelvic pain, but there are many side effects with all drug treatment offered for Endometriosis.

Medical treatment does not improve the chances for pregnancy, and as the treatment is hormonally based, it will delay conception even further due to the hormonal imbalances introduced into the body.

Medical treatment suppresses endometriosis, rather than removing it and is effective only for short term management of symptoms, the active endometriosis returning gradually over 12-24 months after stopping treatment.

The aim of medical treatment is to break the cycle of stimulation and bleeding. By stopping the ovary's usual hormonal cycle and reducing estrogen levels, the endometriosis deposits shrink down and become inactive. The endometriosis is still there, and will gradually become reactivated when the normal menstrual cycle starts again.

Ovarian endometriomas of greater than 3cm diameter are unlikely to respond to medical treatment, and similarly if there is a significant amount of adhesions - these will respond best to laparoscopic surgery.

This aim of drug treatment is to alter the chemical and hormone levels in the body which in turn will affect the natural bodily processes. This will also affect the behaviour of the Endometrial growths.

Pseudo-pregnancy - a state resembling pregnancy - is used as one method to treat Endometriosis, and this can be achieved through hormone drug therapy. This approach was developed by observations that Endometriosis would regress during pregnancy. Pseudo-pregnanacy can be induced by using oral contraceptives containing estrogen and progesterone.

Pseudo-menopause - a state resembling menopause - was developed as another means of treatment because it was observed that Endometriosis also regressed after menopause.

All of these treatments can have various side effects. Some women suffer more than others, but it is advised to be well informed about them before you decide on treatment.

• Contraceptive pill - The Pill is one of the most commonly used treatments for endometriosis, and is often prescribed for young women with mild disease who also require effective contraception. Despite its long-established use, there has been only one study on the use of the Pill for endometriosis. It compared the Pill with GnRH agonists and found an equal improvement with both drugs with regards to pelvic pain, painful periods and painful sex.

• Gestrinone - is a synthetic hormone that effects the production of estrogen by the ovaries. It is taken twice weekly rather than daily. Side effects of Gestinone include: weight gain, acne depression, mood swings, hot flushes and loss of libido. Gestrinone is a treatment used more commonly in Europe. It works in much the same way as danazol with similar, but milder, side effects.

• Danazol - is a mild form of the male hormone testosterone and reduces the amount of estrogen produced by the ovaries to around the same level as during menopause. This is the drug that mimics Pseudo-menopause. Side effects include: weight gain, increased body and facial hair growth, acne, smaller breasts, increased muscle mass, voice deepening and mood swings. Danazol can also cause gastointestinal upsets, depression and liver disease.

• GnRH agonists - GnRH stands for Gonadotrophin Releasing Hormone and an agonist is a drug that acts the same way as the body's own hormone. The body normally makes GnRH in a small gland in the brain (the pituitary) and it is this hormone that stimulates the ovary to develop eggs and produce estrogen, leading to the normal menstrual cycle. If you give GnRH agonists, this floods the system and confuses the delicately controlled balance, leading to a complete block of egg development, estrogen production and menstrual cycle. It effectively makes you 'menopausal' for the time that you use the treatment and without the estrogen stimulation, endometriosis shrinks down and becomes inactive.
  There are several GnRH analogues available. Examples of GnRH agonists include: goserelin (Zoladex), nafarelin (Synarel), Buserelin (Suprecur) and leuprorelin (Prostap). They are all either given by injection or nasal spray - tablet forms are not available.

  Side effects of GnHR agonists include: menopausal symptoms such as thinning of the bones, hot flushes, dry vagina, headaches, depression, loss of libido and night sweats. These side effects can be relieved, by adding back estrogen and progesterone, which does not effect the benefit of treatment. This is known as Add-back therapy for Endometriosis. There is now evidence that the use of Add-back hormone replacement therapy (HRT) is effective in preventing the bone thinning and the unpleasant side effects of GnRH treatment.

  One of the GnRH drugs which has been commonly prescribed for treatment of Endometriosis is known as Lupron. There is a lot of information about this drug on the internet, as well as lots of mention of it at Endometriosis chat groups. This drug is also used for other health problems in both men and women. So it is not designed specifically for the treatment of Endometriosis, and some women have found they now have serious long-term health problems caused by this drug.

Letrozole Treatment-find out more by clicking here:
http://www.KARE2004.com

• Progesterone hormone tablets - oppose the estrogen effects on the endometrial growths which causes them to ‘shrink’. Progesterone also prevents ovulation which lowers the estrogen levels. Side effects include: irregular menstrual bleeding, weight gain, mood changes, bloating, fatigue, depression, and nausea.

  Progestogens are the most commonly used medical treatment. Examples include the drugs medroxyprogesterone acetate (Provera), dydrogesterone and norethisterone.

  It has long been known that progestogens can alter the blood lipids (fats) in an unfavourable way, which might theoretically lead to an increased risk of blood clots (thrombosis). Two recent studies have provided more evidence that this could be the case. Although they looked at progestogens used for period problems, the doses used are similar as would be for treatment of endometriosis, and the risk of thrombosis was around 5-fold higher than expected.

• The Mirena Coil - The Mirena Coil is used by some doctors to treat the symptoms of Endometriosis by reducing the amount of blood flow in a woman’s periods.
  

  The Mirena Coil is like many other types of Intrauterine Contraceptive Devices (IUD's or coils) in that it is fitted by a doctor and remains in the womb for a fixed amount of time, after which it must be changed.
  

  Most IUD's make a woman's periods heavier, but the Mirena actually makes periods lighter than usual. Because of this, it is frequently used as a treatment for heavy periods, and is now used as a treatment option for Endometriosis, for the same reason of reducing blood loss with the menstrual cycle.
  

  It is made of a light, plastic, T-shaped frame with the stem of the 'T' a bit thicker than the rest. This stem contains a tiny storage system of a hormone called Levonorgestrel.
  

  This hormone is also used in contraceptive pills. In the Mirena, however, a much lower dose is released than take the Pill (about 1/7th strength), and it goes directly to the lining of the womb, rather than through the blood stream where it may lead to the common progesterone-type side effects.
  

  Although the IUD was originally developed as a contraceptive, the discovery that it leads to much lighter periods was seen as a bonus. Many gynaecologists now suggest the Mirena as a treatment for heavy periods if tablet treatment doesn't work.
  

  After 3 months use, the average blood loss is 85% less, and by 12 months the flow is reduced by 97% every cycle About one third of women using the IUS will not have any periods at all. There is no 'build up' of blood, because the hormone in the IUD prevents the lining of the womb from building up at all.
  
  Negatives of the Mirena Coil
  
  There are many who feel that the Mirena Coil is very unsuitable as a treatment for Endometriosis as this particular type of Coil increases the risk of developing ovarian cysts.
  

  It is the use of synthetic Progestogen hormones used in the coil that increase the chance of benign ovarian cysts. This is more common with the higher hormone levels associated with the progestagen-only pill. Overall the risk is about 3 times higher. The device could also lead to other complications of infection in the womb.

Most of the current drug treatments on offer aim to reduce Endometriosis growths, and in turn reduce symptoms. Most are reasonably effective to different degrees, however, most are associated with nasty side-effects. Many of the drug therapies have no proven benefit in terms of improvements in fertility or reducing recurrence of the disease.

Surgery:

Surgical treatment for endometriosis is usually carried out in one of the following situations

At the time of diagnosis for mild to moderate endometriosis
If medical treatment has not worked
If subfertility is a problem
If there is moderate to severe endometriosis
When endometriosis recurs

Surgery can either be conservative or radical. The aim of conservative surgery is to return the appearance of the pelvis to as normal as possible. This means destroying any endometriotic deposits, removing ovarian cysts, dividing adhesions and removing as little healthy tissue as possible.

Radical surgery means doing a hysterectomy with removal of both ovaries and is reserved for women with very severe symptoms, who have not responded to medical treatment or conservative operations. Sometimes, if there are other reasons to carry out a hysterectomy it is done earlier than this.

To perform a Laparoscopy a small incision is made, usually about ¼ inch, right underneath the naval. A very small telescope-like instrument is then inserted. This instrument is attached to a light source which illuminates the pelvic and abdominal cavity. The physician can then look directly inside the cavity. During this procedure any Endometrial growths can be removed.

Mild to moderate disease
The endometriosis spots are destroyed by diathermy, where an electric current is passed down a fine probe burning the lesion. Some surgeons use laser to evaporate the endometriosis.

Fine adhesions can be cut using small scissors. Bleeding is usually minimal and having avoided an open operation means that the risk of subsequent adhesion development is reduced. Laparoscopic managment also has the advantage of needing a minimal hospital stay, it is usually possible to go home the same or following day.

Improvement in pain symptoms following this type of surgery can be expected in 70% of cases, moreso if the location of adhesions divided corresponds to the area of maximum pain. There has been only one good quality study of the effect of surgical treatment of mild to moderate endometriosis on subfertility. It found that laparoscopic destruction of lesions resulted in a 13% increase in pregnancy rate - equivalent to, on average, a benefit for one out of every eight women receiving treatment.

Moderate to severe disease
Where endometriosis is more than a few spots, and in particular where there is more severe scarring or an ovarian endometrioma, there is still the option of laparoscopic treatment. The aim of laparoscopy, as usual, is to restore things back to normal. For endometriosis cysts on the ovary, this will mean shelling out and removing the cyst from the underlying normal ovary tissue. An alternative is to make a hole in the cyst wall, empty out the 'chocolate' collection of blood and diathermise the cyst base so all endometriotic deposits are destroyed.

Removal of endometriosis and division of scar tissue can be expected to improve the pain symptoms of endometriosis. The success of surgery in improving subfertility is related to the severity of endometriosis in the first place. It is difficult to give exact estimations, but women with moderate disease can expect pregnancy success rates of around 60%, whereas the comparable figure with more severe disease is around 35%. If a pregnancy does not occur within 2 years of surgery for endometriosis, the chances of success are poor.

For more detailed information about Laparoscopy and Endometriosis please see further

Here is some more info on a laporoscopy, including some tips to prepare:
http://www.endo-resolved.com/laparoscopy_advice.html
http://www.ivf.com/laprscpy.html

For more information about Hysterectomy and Endometriosis check here

Although much relief can be gained from drug or surgical treatment for Endometriosis, it is very common for symptoms to return and for the disease to flare-up again. Additionally, women who use hormone replacement therapy during menopause may also see a return of the disease. This is because hormone replacement therapy uses estrogen along with progesterone to help alleviate the problems associated with the menopause. It is the estrogen drug therapy that will cause the return of symptoms. It is considered by the medical profession to be uncommon for this to happen. But there are many reported cases of women on hormone replacement therapy for the menopause having a return of Endometriosis.

One of the biggest misconceptions about Endometriosis is that pregnancy will cure the disease. Unfortunately this is not the case and most women will see a return of their symptoms after pregnancy, especially if the disease was more advanced. 

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Please also see the page: more endo info which contains many medical resources.

Locating medical Drs. specializing in pelvic pain:
www.pelvicpain.org

ERC Group listing Drs.
http://health.groups.yahoo.com/group/EndoDocs/

Please see Natural Treatments page also, so you can have all the resources available in which to choose from.

Is all of this confusing to you? Is your head spinning? Need some Peace?
a great answer: PRAY, PRAY, PRAY-
see the prayer page.
http://www.theendoclub.com/prayers.htm

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