Endometriosis Treatment Options in Texas: From Medications to Surgery

Endometriosis is the cause of painful menstrual cycles, bowel movements and sexual intercourse for 10% of women in their childbearing years. Many women don’t realize they do not have to live with this pain. Furthermore, pain isn’t the only cause for concern. Endometriosis is linked to infertility and rare types of cancer.

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 treatment options.

Symptoms and Complications of Endometriosis

Although several theories exist to explain the cause of endometriosis, the most plausible is “reverse menstruation.” This is the common occurrence of backflow during menstruation. A small amount of blood (containing endometrial cells from uterine tissue) flows back into the fallopian tubes and the pelvic cavity.

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

Symptoms 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 from a trusted fertility expert. Pain level isn’t a good indicator of the severity of your condition. Even advanced cases can present little or no pain, while mild cases can be excruciating.

Treatment Options For Pain Relief

A fertility specialist should develop a treatment plan based on the severity of your endometriosis, your pain level, and your plans to have children.

Mild, Occasional Pain: If your endometriosis involves occasional, mild pain, our treatment recommendation is over-the-counter nonsteroidal anti-inflammatories, such as ibuprofen or naproxen. This should take the edge off the pain.

Moderate, Relenting Pain: If your pain does not respond to anti-inflammatories, you may consider birth control pills. This approach makes your periods shorter, lighter, and less painful.

Severe, Ongoing Pain: 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. Estrogen lesions require estrogen to grow, without it the lesions will become inactive. 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. It is an oral medication, sometimes referred to as Femara, that directly inhibits estrogen production by the ovaries (not through interference of the pituitary signals to the ovaries as in Lupron or Orilissa). Treating endometriosis with Letrozole is safe, inexpensive, and effective; however, long term use of letrozole can also cause bone loss.

Trying to Conceive with Endometriosis

Nearly half of all women who have endometriosis struggle with fertility issues, ranging from difficulty conceiving to outright infertility. This is due to endometriosis causing:

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

Laparoscopic Treatment: At IVFMD, 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.

Intrauterine Insemination IUI: IUI can increase conception rates for patients with mild endometriosis. Sperm can live for three days inside the uterus but survive for only one hour in the vagina. IUI allows us to introduce motile sperm from your partner directly into your uterus through the cervix. By doing so, we shorten the journey to the egg and give the sperm a better chance of survival.

In Vitro Fertilization (IVF): In more severe cases of endometriosis, a better option is in vitro fertilization (IVF). We stimulate your ovaries to produce multiple eggs, harvest them and fertilize them in a lab to create embryos. Our fertility specialists then transfer the embryo into your uterus, bypassing any endometriosis damage within the tubes or pelvis.

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.