Monday, 19 March 2018

:: COLUMN :: Is there a cure for endometriosis?

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:: This column was originally posted on Endometriosis News ::


Research into endometriosis is advancing and we regularly learn new things about the disease. However, a cure for endometriosis is yet to be identified and this is simply because we are yet to discover the actual cause of endometriosis.

There are many theories behind what causes endometriosis. These include oestrogen production, retrograde menstruation, genetic predisposition, lymphatic or circulatory spread, immune dysfunction, metaplasia and even, environmental causes. But none fully explain why the condition occurs. It is possible that a combination of these factors could cause endometriosis to develop.

There are also several myths floating around regarding the causes of the disease. These include abortion, wearing tampons, sexually transmitted diseases (STD’s), psychological trauma in early life, douching, diet, lack of exercise, contraceptives, the colour of your skin and/or sexual promiscuity. However, there is no evidence any of these factors cause endometriosis. One thing we do know is that there is no way of preventing the disease.

Let’s explore some of the treatment options that are commonly referred to as "cures" for endometriosis.

Pregnancy
During pregnancy, hormones help to regulate the many changes that take place in the body to enable a baby to be born safely. In early pregnancy, a females hormones (which includes oestrogen and progesterone) elevate to help the ovaries release an egg and implant it in to the lining of the uterus. Once an egg embeds in the uterine lining, hormones tell the blood-rich tissue to stay intact to support the growing baby - therefore, the body does not expel the lining as a period.

The symptoms of endometriosis are suppressed during pregnancy but the disease is not eradicated, and symptoms will usually return at some point post child-birth.

There are also cases where some women will only experience symptoms of endometriosis after having a child.

Hormone treatments
Hormone treatments last varying amounts of time. From birth control pills that can be taken for years, to shorter courses of injections like Zolodex or Lupron. 

These drugs act in a similar way to the hormones the body naturally creates during pregnancy, with the aim to stopping periods all together. The symptoms of endometriosis are therefore only suppressed, the disease is not eradicated and symptoms will usually return at some point after the treatment ends. 

Menopause
The menopause is a natural part of ageing that usually occurs in females between 45 and 55 years of age. As oestrogen levels decline, a woman stops having periods and is no longer able to get pregnant naturally.

With the body no longer having a regular menstrual cycle, it is thought that all symptoms of endometriosis should disappear. However, endometriosis can still occur past menopause.

Hysterectomy
A hysterectomy is a surgical procedure where the uterus is removed from a woman’s body. It is probably the most commonly reported ‘cure’ for endometriosis, but, it isn’t one. As endometriosis isn’t limited to the uterus, removing the uterus won’t eradicate endometriosis from other areas of the body. This means endometriosis will continue to grow.

It should be noted, however, that endometrial tissue can also grow in the muscle layers of the wall of the womb, causing a condition called adenomyosis. The only way to eliminate adenomyosis is via hysterectomy.

Surgery
There are a number of different techniques of laparoscopic surgery used in treating endometriosis. These include laser (Light Amplification by Stimulated Emission of Radiation) ablation, electrocoagulation/diathermy, excision surgery, helica thermal coagulator and harmonic scalpel/CUSA (cavitron ultrasonic surgical aspirator).

Techniques such as laser ablation and electrical fulguration are ineffective because they don’t remove all of the endometriosis. With these surgeries, it is thought most patients symptoms return within a year. Excision surgery is seen as the gold standard of care in the treatment of endometriosis. This is because it removes the inflammatory tissue down to its roots, instead of just the tip of the disease. However, excision surgery is still not a cure for endometriosis and symptoms can return.


The phrase “cure” is often thrown around in both the medical world and by sufferers who have found a treatment that has worked for them, who have been led to believe by their doctors that this has subsequently rid them of the disease. However, if these treatments do not remove the disease from the body, and every single microscopic cell of it, the disease is simply suppressed - not eradicated.

Until a cure for endometriosis is discovered, these methods are seen as effective treatment paths in the management of endometriosis pain.

You can follow my Endometriosis News column here.

S.
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