VIDEO: Focus endometriosis treatment on restoring, extending quality of life

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Our nonsurgical approaches for managing endometriosis, and I think it’s a double-edged sword, because you can empirically treat somebody for endometriosis with hormones, and the food for endometriosis is estrogen, and what controls the disease is progesterone. And so, you can basically give progesterone-based treatments. However, there are side effects to hormones. And so one of my things that I feel is that when patients show up with symptoms that seem to be endometriosis, but I’m uncertain, I like to confirm it, because I think, in my opinion, it’s important to have a clear diagnosis before putting people through medications that may not be what they needed if they did not have endometriosis. It’s a great masquerader. And essentially, symptoms of endometriosis can mimic many other diseases, and so it’s good to know what you’re treating before starting treatment.

So, what is the algorithm for treating? Well, if patients have symptoms that are making them dysfunctional, I’ll have patients come in and say, “You know what? Every month when I have a period, I’m nauseated, I’m vomiting, I’m curled up in a ball, I’m missing work, and I just can’t function.” Such a patient, I always offer surgery. So, we can treat there by removing the disease tissue, and then start them on a proper treatment regimen. It can be something simple like birth control pills. It can be a progesterone intrauterine device. It can be injectables. There are multiple kinds of injectables. It can be a nasal spray. It can be a skin implant. It can be a progesterone-only tablet. Any of these things will work for a patient. Sometimes I use aromatase inhibitors, which actually decrease the amount of estrogen they have. I combine that with a hormone therapy such as a progesterone pill. And so, there are nonsurgical approaches to treating. Some younger patients may choose to go with a nonsurgical approach because they don’t want to have, understandably, surgery. Eventually the disease is progressive, and it will get to a point where a patient will need some surgical intervention, which is unfortunate. And something I tell my patients that is really important and when I treat them is that we have treatments, but we don’t have a cure. So even if they have surgery, it’s a high likelihood that they may have a repeat surgery, or their symptoms will recur at some point. And really what we’re doing is we’re trying to restore a normal quality of life for as long as we can until an intervention is necessary again.