• Increased bone loss of close to one percent every month that would to some extent is repealed by additionally consuming low-estrogen dosages. A majority of women reverted to the pre-therapy bone density subsequent to halting the GnRH-a treatment.
• Since the therapy is intended to arrest menses, if one still gets normal menses during the therapy period, then one’s doctor must be promptly informed about it.
• Some women suddenly experience feelings of quite high body heat accompanied by intense perspiration, with redness in the area above the waist, feelings of panic and angst, mild to increased heart palpitations.
• Moodiness, lack of lubrication or dryness in the vagina.
• Plummeting sex drive.
• A rise in levels of cholesterol.
• Lowered HDL or good cholesterol also known as high density lipoprotein.
• Sleeplessness, headache.

The above side effects caused due to decreased estrogen levels are wholly allayed by undertaking estrogen add-back treatment alongside GnRH-a treatment. When the treatment concludes, the bone density eventually picks up though not totally in some cases.

The widely established add-back therapy comprises of low dosage of estrogen and progestin that is believed to cause an adequate surge in the hormone levels so as to be beneficial to the bones, but stopping short of encouraging endometriosis proliferation.  The medications combo comprise of:

• GnRH-a therapy along with estrogen.
• GnRH-a therapy alongside progestin and low dosage estrogen.
• GnRH-a therapy with estrogen, progestin (optional) and etidronate disodium or Fosamax.

Some researchers beg to differ regarding the time and therapy intervals of the add-back treatment. Few doctors consider commencing therapy solely with GnRH-a, prior to employing the add-back treatment. Though latest studies have revealed that getting started with add-back treatment immediately will not impede the endometriosis respite achieved from GnRH-a treatment.

The GnRH-a treatment is quite costly mounting to some hundreds of dollars per month that does not take into account the outlay of add-back therapy. One must desist from GnRH-a, if one is pregnant. Though pregnancy is virtually impossible during the treatment course of GnRH-a as menses are halted, yet it is advisable to employ the barrier techniques of birth control, for instance condoms when undergoing the treatment course.

Read more at: GnRH-a Therapy: An Effectual Endometriosis Treatment – Part I

Endometriosis

In Endometriosis, there is no sure-shot means to envisage the rate of worsening, improvement or remaining unchanged till menopause. These implants could proliferate to the ovaries, fallopian tubes, the external surface of uterus or several other organs in the abdomen. In atypical cases, organs beyond the abdominal region are also affected.

Endometriosis Causes:

The specific causes leading to endometriosis is still unidentified. Probable reasons comprise of the following:

• An improper functioning immune system that fails to obliterate any endometrial cells growing on the outer surface of the uterus.
• In a majority of women, the bleeding occurring during the menstrual cycle has endometrial cells that are passed up via the fallopian tubes into the abdomen known as retrograde menstruation. Matters aggravate in those who face heavy monthly bleeding or have congenital structural defect of the uterus, vagina or cervix, leading to the blockage or slowing down of the menstrual flow.
• Along with the movement of blood or lymph fluid, the endometrial cells also get moved to other sites in body.
• Surgical intervention undertaken during a C-section or an episiotomy done subsequent to child delivery, the endometrial cells may be carried to a different part of the body.
• The cellular structure present in the abdominal and pelvic region that are nearly associated with the cells present in the reproductive system could transform into endometrial cells.
• Prior to birth, the endometrial cells could get accumulated on the outer surface of the uterus.
• Genetic pre-disposition to develop endometriosis.

Endometriosis Symptoms:

The symptoms of endometriosis intensify just prior to and through the menstrual bleeding cycle, improving as the periods halt. While some women mostly teenagers experience persistent pain that doesn’t get better during the monthly periods. Symptoms comprise of:

• Pain experienced in the pelvic or rectal region.
• Chronic menstrual spasms.
• Heightened pain in the lower back just one to two days prior to the commencement of periods or before, that lessens through the periods.
• Experiencing pain while doing bowel movements.
• Nearly twenty to forty percent infertile women have endometriosis that indicates that infertility is the singular pointer to the presence of endometriosis.
• Unnatural blood loss during bowel or bladder movements, spotting prior to the monthly period time, bleeding from the vagina subsequent to intercourse.
• Large endometrial implants don’t essentially cause greater pain rather the associated pain and blood loss are interrelated to the position or the depth of the implant’s growth.
• Adenomyosis, agonizing, heavy menstrual periods, non-malignant cell proliferation in the uterus known as uterine fibroids causing analogous symptoms to that of endometriosis.
• Inability to conceive despite active attempts for a year’s time.

Endometriosis Exams & Tests:

To determine whether endometriosis is the root cause of the symptoms displayed, the doctor would initially seek a detailed overview of the patient’s general and family medical past, the symptoms displayed and the monthly periods.

• A pelvic examination would be done that would involve scrutinizing the vaginal and rectal region to check the spread of endometriosis.
• If an unnatural clump or accumulation is detected on an ovary in the course of a pelvic examination, then it could indicate the presence of ovarian endometrioma- a cyst formation full with endometrial cells located on an ovary. To examine such dubious cyst formations scanning techniques like trans-vaginal ultrasound, CT or CAT scan and MRI scan are employed.

Endometriosis Treatment:

Though endometriosis has no cure, the treatment carried out would assist in allaying pain and to treat sterility. The treatment is dependent on the severity of the symptoms and the option for imminent pregnancy.

• If the above procedures indicate the presence of endometriosis, then the doctor would suggest a preliminary intake of NSAID’s or Non-steroidal anti-inflammatory drugs with or without hormone therapy prior to undergoing any further tests. If these provide relief, then the analysis of endometriosis is a certainty. Birth control hormones like patches, pills or ring advised during hormone therapy assist in stunting the endometrial growth thus averting further aggravation and lowering pain. These anti-inflammatory medications can be taken for protracted periods of time without the fear of any major side effects.
• If NSAID’s or hormone therapy is not helping or symptoms are chronic, then more potent hormone therapy known as GnRH-a, Mirena –a progestin based intra-uterine apparatus, danazol or aromatase inhibitors are suggested. But, prior to this, a laparoscopy procedure is undertaken to accurately examine the inner organs for symptoms of endometriosis in the pelvic region.
• Hormone therapy subsequent to surgery has shown to prolong the painless phase and avert new growth or a recurrence of endometriosis. Some experienced relief from pain subsequent to surgery while nearly twenty percent of operated women found no marked relief.
• In extreme cases, the uterus and the ovaries have to be removed by either hysterectomy or oophorectomy that leads to premature menopause. It is an option for those who either don’t intend to get pregnant or have no improvement after trying other treatments. Even following this major surgery, nearly fifteen percent women still complained of pain.
• In those with mild to moderate ranging endometriosis, Laparoscopic surgery is done to remove the endometrial implants to heighten the likelihood of pregnancy and allay pain.

Endometriosis Possible Complications:

The major complication associated with endometriosis is sterility. The extended period of time one has endometriosis, more is the likelihood of becoming sterile.

Sometimes, endometrial implants manifest themselves into cancerous forms, though the proliferation rate of these tissues is not greater in comparison to other tissues. The risk to getting uterine cancer or ovarian cancer is not heightened due to the presence of endometriosis.

Endometriosis Prevention:

As its causes are still undecipherable, there are no precise guidelines to controlling the risk factor of endometriosis, though those women after child delivery are less prone to getting endometriosis in comparison to those that have not given birth.