When considering treatment of endometriosis, each patient must be aware of the available choices and the expected benefit of each option. With Dr. Arrington’s help each patient will use her experience and personal health goals to chose an appropriate treatment.
First to consider is hormonal therapy. Most patients are offered hormonal therapy well before the diagnosis of endometriosis is actually made. This may come in the form of birth control pills (BCPs), progesterone only pills (POPs), long acting progesterone medicines, and GnRH agonists such as Lupron or Zoladex. It is important to understand that the goal of any hormone or medical therapy is to control the symptoms of endometriosis. Usually the control of pain associated with the disease. Hormones are not meant to make the disease “go away”. In some patients, hormones can help them be more comfortable on a daily basis. Usually the symptoms will return after the hormone therapy is stopped.
This is critical to understand when considering GnRH agonist therapy. These are very potent hormone medicines that place patients into a temporary state of menopause. Due to side effects such as bone loss, these therapies are limited to 9-12 months of use. Usually the bone loss recovers, but it may not if repeated courses of therapy are used. Up to 12% of patients will also have prolonged ovarian failure. Once the medicine is stopped, nearly 75% of patients will have a return of symptoms. The disease does not “magically go away.”
Surgery is another treatment option. There is a wide variety in the surgery offered for endometriosis. At EndoWest, we believe that the goal of surgery should be the “complete excision of all visible disease.” This means that a surgeon must have the ability to fully remove the endometriosis regardless of where it is located or what organs may be involved. Only gynecologists with advanced surgical skill are trained to remove endometriosis in critical areas such as the deep pelvic sidewall, intestines, bladder and around ureters. Using his fellowship training as a background, Dr. Arrington has spent his career improving his technique and ability to remove endometriosis in these areas.
Many patients have had prior surgical treatment of endometriosis. Unfortunately many of them have had incomplete treatment of the disease due to not recognizing all forms of endometriosis or due to a surgeon who does not have the skills to remove the disease near or in critical organs. See the Dandelion Analogy.
One final word. Hysterectomy IS NOT definitive treatment for endometriosis. Think about it for a second. By definition, endometriosis occurs outside the uterus. How can this disease be treated by removing a normal organ but leaving the disease behind. It makes no sense. In fact, hysterectomy is rarely needed to treat endometriosis. It is better to actually remove the disease that is causing the problem.