Post-Surgery Treatment Options for Endometriosis: Addressing Concerns

Follow-up treatment for endometriosis?

Hello Doctor: I underwent laparoscopic surgery for a 5 cm chocolate cyst and a 0.5 cm uterine fibroid at the end of February this year.
I also received six doses of Lupron, with the last injection on July 25, 2012.
In between, I took Letrozole for one month, divided into two months, to improve my difficulty sleeping and hot flashes, but this medication did not seem effective for me.
On August 10, when I returned to the hospital for a Pap smear, the attending physician directly prescribed oral contraceptives without discussing side effects or out-of-pocket costs.
I would like to ask the doctor: 1.
I do not plan to get pregnant and have been undergoing treatment for six months; should I continue taking contraceptives? 2.
I have heard that the contraceptives prescribed by the hospital can cause weight gain, and I already weigh 82 kg.
I also have a history of migraines, poor metabolism, and frequent allergic reactions affecting various parts of my body.
I am concerned about the potential harm to my detoxification organs from the medication.
I am unclear about the effectiveness of contraceptives.
3.
If I must take contraceptives, are there options with fewer side effects? Why can't patients choose better medications if they are paying out of pocket? The attending physician mentioned that I need to start taking them by August 26, and that not taking contraceptives could lead to potential consequences, which is quite distressing.
I kindly ask for your assistance in answering the above questions.
Thank you very much!

akiko, 30~39 year old female. Ask Date: 2012/08/16

Dr. Lin Wenbin reply Obstetrics and Gynecology

Endometriosis can be treated post-surgery with adjunctive therapy using GnRH agonists, or steroid hormone anti-progestins such as Danazol or Gestrin (oral), or general female hormone preparations like oral contraceptives.
If the injection therapy is deemed ineffective, additional oral medications can be considered for treatment.
The necessity for further treatment and the choice of medication should be determined through an in-person evaluation by a physician, preferably the original surgeon, to better understand the condition.
If there is also an issue with overweight, consultation with a metabolic specialist is recommended, as excess body fat can interfere with ovarian secretion of female hormones.
It is important to note that not all oral medications are contraceptives, so a discussion with the physician is essential to decide which type of medication should be chosen.

Reply Date: 2012/08/16

More Info

Post-surgery treatment options for endometriosis can be complex and often require a personalized approach based on individual symptoms, medical history, and treatment responses. Given your recent surgery for a chocolate cyst and uterine fibroid, as well as your ongoing concerns about hormonal treatments, let’s address your questions and provide some insights into the management of endometriosis.

1. Continuation of Birth Control Pills: Birth control pills are commonly prescribed for managing endometriosis symptoms, particularly for pain relief and to regulate menstrual cycles. Since you mentioned that you are not planning to conceive in the near future, continuing with hormonal therapy like birth control pills can be beneficial. They work by suppressing ovulation and reducing estrogen levels, which can help minimize the growth of endometrial tissue and alleviate pain. However, the decision to continue should be made in consultation with your healthcare provider, considering your specific symptoms and any side effects you may experience.

2. Concerns About Side Effects: It is understandable to be concerned about the potential side effects of hormonal contraceptives, especially if you have a history of migraines, weight gain, and allergic reactions. While some women do experience weight gain on birth control pills, this is not universal, and many factors contribute to weight changes, including lifestyle and metabolism. It’s important to discuss your concerns with your doctor, who can help you weigh the benefits of symptom relief against the risks of side effects. If you experience significant side effects, your doctor may consider alternative hormonal therapies or non-hormonal options.

3. Alternative Options and Patient Choice: If you are hesitant about taking the prescribed birth control pills, it’s crucial to communicate this with your healthcare provider. There are various hormonal and non-hormonal treatment options available for endometriosis, including:
- GnRH Agonists: These medications can induce a temporary menopause-like state, reducing estrogen levels and alleviating symptoms. However, they can have significant side effects and are typically used for limited durations.

- Progestins: These can be taken in various forms (pills, injections, or IUDs) and may have fewer side effects than combined oral contraceptives.

- Non-hormonal options: Pain management strategies such as NSAIDs (non-steroidal anti-inflammatory drugs) can help alleviate pain without hormonal side effects. Additionally, lifestyle modifications, physical therapy, and alternative therapies like acupuncture may provide symptom relief.

It is essential to have an open dialogue with your healthcare provider about your treatment preferences and concerns. If you feel that your current provider is not addressing your needs adequately, seeking a second opinion from another specialist in endometriosis or reproductive health can be beneficial.
In summary, while hormonal treatments like birth control pills are often effective for managing endometriosis, they are not the only option. Your treatment plan should be tailored to your individual needs, preferences, and medical history. Always feel empowered to ask questions and advocate for your health, ensuring that you are comfortable with the treatment plan you choose.

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