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Consider Your Treatment Options for Endometriosis

Admittedly, there’s a measure of relief that comes from finally hearing a definitive diagnosis to validate your painful menstrual cycles, bowel movements, and sexual intercourse. But once you learn you have endometriosis, your thoughts, and ours, turn immediately to your treatment options.

Our team of experienced gynecologists and fertility specialists here at IVFMD, helps thousands of women navigate this serious condition and make informed decisions about their own health. Endometriosis affects up to 10% of women in their childbearing years, and it’s linked to infertility and some rare types of cancer, so we encourage all our female patients to understand this condition and its potential treatments.

Complications of endometriosis

Although several theories exist to explain the cause of endometriosis, the most plausible is “reverse menstruation.” This describes the common occurrence of backflow during menstruation when a small amount of blood flows back into the fallopian tubes and the pelvic cavity.

If your immune system doesn’t recognize the endometrial cells outside their assigned region of your uterus, they survive and stick to the walls and surfaces of other organs, where they continue to grow and respond to hormonal cues, thickening and bleeding with each cycle and causing symptoms.

Symptoms suggestive of endometriosis can include:

  • Painful periods,
  • Painful intercourse
  • Painful bowel movement
  • Infertility

Endometriosis shares these symptoms with other conditions, so it’s important to get an accurate diagnosis. And if you do have endometriosis, your pain level isn’t a good indicator of the severity of your condition, as even advanced cases may present little or no pain, while mild cases can be excruciating.

Treatment options for endometriosis

After our team has assessed your condition, we discuss your treatment options. Determining the best plan for your case depends on the severity of your endometriosis, your pain level, and your plans to have children.

Treatment for pain relief

If your endometriosis is occasionally painful and relatively mild, over-the-counter nonsteroidal anti-inflammatories, such as ibuprofen or naproxen can take the edge off when you have a flare-up.

Birth control pills can help by making your periods shorter, lighter, and less painful.

To control severe endometriosis pain, suppression of estrogen production from the ovaries is necessary for long term relief. Here are the options.

  • Lupron DepotⓇ: This is  an injectable medication that interferes with the signal between your pituitary gland and your ovaries.  Lupron puts your ovaries into a dormant state and stops the production of estrogen to make the endometriosis lesions inactive since they require estrogen to grow. After a couple of weeks of use, your estrogen level will drop and the pain relief begins and can last for months.   . Unfortunately, Lupron can only be used up to 6 months per year since longer use can result in the loss of bone mass (osteoporosis).
  • Orilissa: This is a new oral treatment option for endometriosis. It works by blocking the release of hormones from the pituitary to the ovaries, thus making the ovaries inactive and stops the production of estrogen. Unlike Lupron, Orilissa is an oral tablet and is therefore easier to use. Studies have shown that Orilissa is as effective as Lupron. It is newly available so it might be more expensive. Similar to Lupron, Orilissa should not be used continuously for more than 6 months to avoid loss of bone density.
  • Letrozole: This is a third medical option to treat endometriosis. Letrozole (or Femara) is an oral medication that directly inhibits estrogen production by the ovaries (not through interference of the pituitary signals to the ovaries as in Lupron or Orilissa). Letrozole is safe, inexpensive, and effective; however, long term use of letrozole can also cause bone loss.

Treatment to aid conception

If you want to become pregnant but are battling with endometriosis, you may face a few challenges. Nearly half of all women who have endometriosis struggle with fertility issues as well, ranging from difficulty conceiving to outright infertility, for several reasons:

  • Scarred or blocked fallopian tubes
  • Inflamed pelvis
  • Adhesions
  • Distorted pelvic anatomy
  • Immune disorders
  • Implantation interference
  • Impaired egg or sperm quality

During the diagnostic stage, we may use a laparoscopic procedure to better visualize the endometrial lesions and determine the extent of the condition. During the procedure, we may be able to remove or burn away the lesions and scar tissue, giving you a better chance of becoming pregnant.

Another way to increase conception rates in case of mild endometriosis is through intrauterine insemination (IUI). This allows us to introduce motile sperm from your partner directly into your uterus through the cervix, shortening their journey to the egg and giving them a better chance of survival. Sperm can live for 3 days inside the uterus but survive for only 1 hour in the vagina.

IUI works well only in cases of mild endometriosis. In case of severe endometriosis, a better option is in vitro fertilization (IVF). Here, we stimulate your ovaries to produce multiple eggs, harvest them, fertilize them in a lab to create embryos, then transfer the embryo into your uterus, bypassing the tubes and the pelvis that might be damaged by endometriosis.

Surgical treatment for endometriosis

If you’re past your childbearing years or are certain you have no plans to get pregnant, you may opt for a permanent surgical solution for endometriosis. During this procedure, your uterus and/or your ovaries and fallopian tubes are removed. This major surgery should only be the last option when other treatments fail to relieve the pain associated with endometriosis.

To learn more about your endometriosis treatment options, schedule an appointment with one of our specialists at IVFMD in Irving, Grapevine, or Arlington, Texas, by phone or request an appointment online today.


Sy Le, M.D.
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