Endometriosis Treatment

Endometriosis is one of the most common gynaecological conditions that women of childbearing age can suffer from. Women with endometriosis often suffer from severe pain, such as chronic abdominal or pelvic pain, painful menstruation, painful intercourse and painful urination. Endometriosis can lead to systemic inflammation, mood disorders and infertility, resulting in a reduced quality of life.

What treatment options are available for women suffering from endometriosis? And is there any progress in finding natural alternatives? In this blog series (3 parts), we get to the bottom of the matter and explore the latest findings on how endometriosis works and what treatment options are available.

In the first part, we will focus on the facts about endometriosis and the conventional treatment options. In the second, we will examine the mechanism of action of endometriosis and the role of the endocannabinoid system as a new therapeutic target. Finally, in the third part, we will present the alternative therapeutic options for endometriosis.
With our FemMag, we would like to offer a platform for the exchange of experiences. If you or your loved ones suffer from endometriosis, feel free to share your experiences and therapy tips with other people affected.

What is endometriosis and who is affected?

Before we talk about treatment options, you may be wondering what endometriosis actually is? Endometriosis is a painful gynaecological condition that affects women of reproductive age and severely impacts every aspect of their lives. Endometriosis is classically defined as a chronic gynaecological condition characterised by endometrial-like tissue outside the uterus and thought to arise from retrograde menstruation. However, this description is outdated and no longer reflects the true extent and manifestations of the disease.

For a long time, it was incorrectly assumed that endometriosis was primarily an abdominal disease, but in the last 15 years, research has documented the systematic consequences that women may suffer. For example, endometriosis also affects liver metabolism, leads to systemic inflammation and alters gene expression in the brain, leading to pain sensitisation and mood disorders. The full effects of the disease are not yet fully understood and go far beyond the abdomen. This is why endometriosis is now considered a systemic disease.

Endometriosis is a common gynaecological condition and affects about 10% of women and girls of childbearing age worldwide, a total of about 190 million. In addition, endometriosis is observed in 50-80% of women with severe abdominal pain and in up to 50% of women suffering from infertility. Unfortunately, there are no reliable figures from Germany on the prevalence and incidence of endometriosis – data on treatment prevalence varies between 0.8 and 2%.

What are the effects and consequences of the disease?

Despite the widespread prevalence of endometriosis, the disease is not recognised well enough. Diagnosis times range from 4 to 11 years and gynaecologists and general practitioners initially misdiagnose 65% of women. In addition, women often report that the symptoms they experience are inappropriately normalised by society. This is mainly due to a general lack of knowledge about the topic and again highlights the need to close the gender data gap.

Endometriosis has a strong impact on women’s quality of life, affecting their work, leisure, social and romantic relationships. The negative effects of endometriosis symptoms include infertility, sexual difficulties and chronic pain. A growing body of research shows that endometriosis-related chronic pain is the main cause of the disease’s negative impact on various areas of life.

In addition, endometriosis significantly affects women’s productivity and employment. According to the Global Burden of Disease Study (1990-2017), endometriosis caused 4.1 million lost healthy life years (DALYs) worldwide, accounting for more than one-third of the DALYs of all gynaecological diseases combined (11.9 million). Symptoms such as fatigue, mood swings and heavy bleeding lead to absenteeism or the inability to work long hours. Therefore, the economic burden of endometriosis should not be underestimated, both for the individual and the community, as this disease leads to a loss of productivity in the workplace and a high consumption of health resources. The national cost of endometriosis was estimated at €1.96 billion in 2003. With costs of almost 2 billion Euros, endometriosis is a disease that cannot be neglected from an economic point of view.

Today’s treatment options at a glance

Currently, healthcare providers offer several treatment options to relieve pain associated with endometriosis, such as hormone therapy, painkillers and even surgical treatments. However, which options are realistic for a woman depends on her age, the severity of her symptoms and whether she wants to have children. Conventional medications (NSAIDs and hormone treatments) have limited efficacy and problematic side effects, with discontinuation rates of 25-50%.

Hormone therapy

Because endometriosis is oestrogen-dependent, hormonal treatments are mainly aimed at reducing oestrogen production by the ovaries. Currently, the most common pharmacological approaches to hormone therapy include progestogen, progestin and gonadotropin-releasing hormone (GnRH) analogues. Although these hormone therapies are established methods of treating endometriosis, there is a lack of valid data to assess their efficacy, symptom relief, impact on fertility and likelihood of recurrence in the long term. In addition, hormone therapies for the treatment of endometriosis are often not suitable for long-term use because of their potential side effects.

Pain medication

In addition to hormone therapy, anti-inflammatory drugs aka. non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often used to treat milder pain symptoms. However, current scientific evidence is not sufficient to support this use, and NSAIDs should not be used long-term because they can cause unpleasant side effects.

Surgical interventions

Research shows that some surgical treatments can relieve the pain associated with endometriosis. Therefore, health care providers may suggest surgery to treat severe pain. During surgery, the surgeon may locate the endometriosis areas and remove the endometriosis patches if they think it is necessary. However, these surgical treatments are associated with a high recurrence rate of up to 50% within five years of surgery, so surgery is not a guaranteed long-term solution.

Women with endometriosis report that non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal drugs have limited efficacy and problematic side effects, resulting in discontinuation rates of between 25 and 50 %. So, it seems that the most common medical therapies for treating endometriosis have side effects that limit their long-term use. At the same time, surgical treatments may not provide long-term relief either. Therefore, it is important to continue searching for safe and effective long-term treatments.

Outlook

In the next part of this series, we will look at the mechanism of action of endometriosis and the role of the endocannabinoid system as a new therapeutic target.