ENDOMETRIOSIS TREATMENTS

At the moment, there's no sure cure for endometriosis. The options range from doing nothing to undergoing fairly invasive surgery, and your approach will depend on how severe your symptoms are and whether you're trying to get pregnant. Many women with endometriosis simply control the pain with painkillers and take birth control pills to moderate the bleeding and cramping that come with their periods. If your symptoms are severe enough so that you need to go on the offensive, though, you can go in any of several directions.

Drugs. Doctors can stop the menstrual cycle with drugs that mimic pregnancy or menopause, but clearly this isn't helpful for women who want to conceive. Some doctors prescribe Depo-Provera to stop menstruation altogether. Another common treatment is danazol, which is a modified male androgen that can replace oestrogen; unfortunately, its predictable side effects include excess hair growth, decreased breast size, and a lowered voice register. Drugs belonging to the category of gonadotropin-releasing hormones (GnRH) work by inducing a pseudo-menopause and thus encouraging the endometriosis to regress, but they're only a short-term fix: their use is limited to a maximum of six months over a woman's entire lifetime. If conception is your primary goal, several studies have shown that there's promise in the use of fertility drugs, along with artificial insemination.

Some gynaecologists use a cream containing natural progesterone as their first line of treatment. Applied twice a day, the cream works by reducing oestrogen's effect on endometrial lesions. As an alternative, some doctors prescribe natural progesterone capsules.

Surgery. A tiny device called a laparoscope allows the doctor to see cysts and lesions, which can then be surgically removed or vaporised with a laser. The surgeon can also cut adhesions, places where organs are bound together. New developments in laser technology are making this kind of surgery faster and more accurate. The surgeon must remove as much of the misplaced endometrial tissue as possible to prevent it growing back, meanwhile trying to avoid any additional scarring. Studies show that this surgery significantly increases your chances of becoming pregnant. In the past, a hysterectomy (and sometimes removal of the ovaries as well) was a common treatment for severe endometriosis. Today most doctors consider it a last resort, reserved primarily for women who don't want to conceive or are menopausal. Keep in mind that this extreme measure doesn't guarantee a cure; some people have continued to suffer from endometriosis even after having their reproductive organs removed.

Alternative remedies. Fish-oil supplements have been shown to decrease menstrual cramps and are probably worth trying, since they're relatively harmless. Naturopaths or gynaecologists trained in integrative medicine may also suggest a change in diet, since that can help reduce the excess oestrogen your body is producing; they might recommend that you eat foods containing fatty acids (such as salmon or nuts) every day, lessen the amount of meat and dairy foods that you eat, increase your consumption of soy products and cruciferous vegetables like cabbage and broccoli, and take a multivitamin-mineral supplement. There is no real evidence however, that dietary intervention is of any help.

Some women with endometriosis report good results after turning to traditional Chinese medicine, homeopathy, massage, or allergy management (although no research has yet documented the effectiveness of these unconventional approaches). If the disease is causing you pain or disruption, and if other remedies haven't provided relief, it may be worthwhile to experiment with one or more of these options. Talk with your doctor about any alternative methods you've adopted, and be sure to list all the herbal preparations or supplements you're taking; some can interfere with prescription and over-the-counter medicines.