Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Endometriosis can be treated with medications and/or surgery. The goals of
endometriosis treatment may include pain relief and/or enhancement of fertility.
Medical treatment of endometriosis
Nonsteroidal anti-inflammatory drugs or NSAIDs (such as ibuprofen or naproxen sodium) are commonly prescribed to help
relieve pelvic pain and menstrual cramping. These pain-relieving medications
have no effect on the endometrial implants. However, they do decrease
prostaglandin
production, and prostaglandins are well-known to have a role in production of
pain sensation. Because the diagnosis of endometriosis is only definite after a
woman undergoes surgery, there will of course be many women who are suspected of
having endometriosis based on the nature of their pelvic pain
symptoms. In such a situation, NSAIDs are commonly used, such as naproxen or
ibuprofen, are commonly used. If they work to control
pain, no other procedures or medical treatments are needed. If they do not
relieve the pain, additional evaluation and treatment generally occur.
Since endometriosis occurs during the reproductive years,
many of the available medical treatments for endometriosis rely on interruption
of the normal cyclical hormone production by the ovaries. These medications
include GnRH analogs, oral contraceptive pills, and progestins.
Gonadotropin-releasing hormone analogs (GnRH analogs) have been effectively
used to relieve pain and reduce the size of endometriosis implants. These drugs
suppress estrogen production by the ovaries by inhibiting the secretion of
regulatory hormones from the pituitary gland. As a
result, menstrual periods stop, mimicking menopause. Nasal and injection forms of GnRH agonists are
available.
The side effects are a result of the lack of estrogen, and include:
Fortunately, by adding back small
amounts of estrogen and progesterone in pill form
(similar to treatments sometimes used for symptom relief in
menopause) many of the annoying side effects due to estrogen deficiency can be
avoided. "Add back therapy" is the term that refers to this modern way of
administering GnRH agonists along with estrogen and progesterone in a way to
keep the treatment successful, but avoid most of the unwanted side effects.
Oral contraceptive pills
Oral contraceptive pills (estrogen and progesterone in
combination) are also sometimes used to treat endometriosis. The most common
combination used is in the form of the oral contraceptive pill (OCP). Sometimes women who have severe
menstrual pain are asked to take the OCP continuously, meaning skipping the
placebo (sugar pill)
portion of the cycle. Continuous use in this manner will free a woman of having
any menstrual periods at all. Occasionally, weight gain,
breast tenderness,
nausea, and irregular bleeding are mild side effects.
Oral contraceptive pills
are usually well-tolerated in women with endometriosis.
Progestins
Progestins [for example,
medroxyprogesterone
acetate (Provera, Cycrin, Amen), norethindrone acetate,
norgestrel acetate (Ovrette)] are more potent than birth
control pills and are
recommended for women who do not obtain pain relief from or cannot take a birth
control pill.
Since the
absence of menstruation (amenorrhea) induced by
high doses of progestins can last many months after cessation of therapy, these
drugs are not recommended for women planning pregnancy.
Other drugs used to treat endometriosis
Danazol (Danocrine)
Danazol (Danocrine) is a synthetic drug that creates a high androgen (male type
hormone) and low estrogen hormonal environment by interfering with ovulation and
ovarian production of estrogen. Eighty percent of women who take this drug will
have pain relief and shrinkage of endometriosis implants, but up to 75% of women
develop side effects from the drug.
All of these changes are reversible, except for voice changes; but the
return to normal may take many months. Danazol should not be taken by women with
certain types of liver, kidney, and heart conditions.
Aromatase inhibitors
A newer approach to the treatment of endometriosis has involved the
administration of drugs known as aromatase inhibitors [for example,
anastrozole (Arimidex) and
letrozole (Femara)]. These drugs act by interrupting local estrogen
formation within the endometriosis implants themselves. They also inhibit
estrogen production in the ovary, brain, and other sources, such as adipose
tissue. Research is still ongoing to characterize the effectiveness of aromatase
inhibitors in the management of endometriosis. Aromatase inhibitors cause
significant bone loss
with prolonged use and cannot be used alone without other medications in
premenopausal women because they stimulate development of multiple follicles at
ovulation.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Menstrual cramps (pain in the belly and pelvic area) are experienced by women as a result of menses. Menstrual cramps are not the same as premenstrual syndrome (PMS). Menstrual cramps are common, and may be accompanied by headache, nausea, vomiting, constipation, or diarrhea. Severity of menstrual cramp pain varies from woman to woman. Treatment includes OTC or prescription pain relief medication.
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Symptoms include abdominal pain, amenorrhea, and vaginal bleeding. Treatment options include observation, medication, or surgery.
Though uterine cancer's cause is unknown, there are many factors that will put a woman at risk, including: over age 50, endometrial hyperplasia, using hormone replacement therapy, obesity, using tamoxifen, being Caucasian, having colorectal cancer. Symptoms of cancer of the uterus (endometrial cancer) include abnormal vaginal bleeding, painful urination, painful intercourse, and pelvic pain. Treatment depends on staging and may include radiation therapy or hormone therapy.
Ovarian cysts are fluid-filled, sac-like structures within an ovary. Causes of ovarian cysts are numerous. Symptoms of an ovarian cysts may be pain in the belly or pelvis. Treatment of an ovarian cysts depends on type of cyst.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
Infertility is the diminished ability to conceive a child. The primary cause of infertility in men is a sperm disorder. In women, the primary cause of infertility is an ovulation disorder. Most forms of infertility can be treated. Conventional infertility therapies include drugs or surgery.
Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Menstrual cramps and premenstrual syndrome (PMS) symptoms include abdominal cramping, bloating, a feeling of fullness, abdominal pain, mood swings, anxiety and more. Treatment for menstrual cramps and premenstrual syndrome (PMS) symptoms include regular sleep, exercise, smoking cessation, diet changes, and OTC or prescription medication depending on the severity of the condition.
Sexual dysfunction refers to a problem that arises during any phase of the sexual response cycle, preventing an individual or couple from experiencing sexual satisfaction. Physical, medical, and psychological conditions may affect sexual functioning, resulting in inhibited sexual desire, inability to become aroused, lack of orgasm, and painful intercourse. Treating the underlying physical and psychological problems usually resolves most female sexual problems.
Trying to get conceive, or become pregnant can be challenging, frustrating, and an emotional rollercoaster for some couples. There are things you can do to chart progress, which may ultimately lead to a successful healthy pregnancy, or, when necessary, lead to discussions with a fertility specialist. Being aware of your menstrual cycle, charting your fertility pattern, knowing the reasons for infertility, and treating infertility are key points to discuss with your partner and physician.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Surgical menopause happens when a premenopausal woman has her ovaries removed in a surgical procedure called a bilateral oophorectomy. An abrupt menopause follows, with women often experiencing more severe menopausal symptoms than if they were to go through natural menopause. Chemotherapy and pelvic radiation therapy may also cause menopause by damaging the ovaries.
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