What is endometriosis?
Endometriosis is a chronic disease defined by the presence of endometrial glands (glands that normally sit inside the walls of the uterus) at sites outside of the uterus, including the ovaries, fallopian tubes, vagina and bladder. They can even reach the lungs. This abnormal growth of uterine tissue can cause debilitating period pain and cramping as well as pelvic pain, back pain, painful intercourse and even painful bowel movements.
Endometrial glands are fed by estrogen, which is why medications used to treat endometriosis target estrogen and related hormones. Treatment of endometriosis can be lifelong.
What causes endometriosis?
Briefly, there is considerable controversy as to the exact cause of endometriosis, but here are some interesting leading theories:
How do I manage endometriosis with medications?
As there is no definitive cure for endometriosis yet, medications for endometriosis aim to help patients better manage its painful symptoms and slow down the growth uterine tissue outside of the uterus.
Mild to moderate pain
Ibuprofen (Motrin) and naproxen (Naprosyn) are the best-studied NSAIDs (nonsteroidal anti-inflammatory drugs) for endometriosis pain, so that’s where you’d start.
Another good option is oral contraceptives (birth control pills). Together with NSAIDs, they provide relief of symptoms for many women. No single oral contraceptive has been shown to be better than another. Most doctors recommend starting with a low-dose combination estrogen/progesterone pill.
Pro tip: If you’re trying for pregnancy, stick with a regular NSAID instead of a selective COX-2 inhibitor like celecoxib (Celebrex). Some studies show that selective COX-2 inhibitors can prevent or delay ovulation.
Severe pain
If you don’t experience relief from NSAIDs, your next option might be to try a GnRH (gonadotropin releasing hormone) agonist. These reduce the amount of estrogen made by the ovaries. Two effective regimens are Lupron (leuprolide), an intramuscular injection given every month or three months, and Synarel (nafarelin), a nasal spray taken twice daily.
While you are on a GnRH agonist, your doctor will add Aygestin (norethindrone acetate), a form of the hormone, progesterone, to minimize bone loss and other effects of low estrogen.
What is Orilissa and how does it work?
Just approved by the FDA in July, Orilissa is another option for moderate to severe pain due to endometriosis. Orilissa suppresses the release of GnRH, which reduces how much estrogen is released from the ovaries.
Unlike Lupron and Synarel, which take seven to 14 days to work, Orilissa is effective immediately. Orilissa comes as a tablet in doses of 150 mg taken once daily for up to 24 months, or 200 mg taken twice daily for up to six months.
Pro tip: Orilissa is currently being studied as a treatment for uterine fibroids where it appears to be effective at reducing heavy bleeding.
Dr O.
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