Endometriosis is a common disease that affects women of childbearing age and is the most common reason for women to have their ovaries removed. Endometriosis is hard to describe, but it is implants of the same tissue that normally lines the uterus and bleeds monthly for a period, but it is found in the wrong place—on the outside of the uterus, tubes and ovaries, and the intestines. When this tissue is located in the abdomen, without the protection of the uterus, it swells and bleeds monthly causing intra-abdominal bleeding experienced as severe abdominal pain. This tissue also excretes estrogens and prostaglandins that cause inflammation and prevent pregnancy. Eventually, these implants cause scarring of the tubes, uterus and the bowel that causes pain other than during a period.
This condition has had many treatments, mostly based on starving the implants of estrogen—birth control pills, Lupron that puts women into a menopausal state, and an old drug Danocrine, and burning them with laser through a laparoscope. The new research today is from the Journal Steroids in Neuroendocrine Immunology and Therapy of Rheumatic Disease, which acknowledges the fact that these endometriotic implants secrete estrogens and inflammatory cells that cause the downstream problems, and that this disease has a new non-invasive treatment—aromatase enzyme inhibitors! These are drugs that stop the conversion of testosterone to estrone and estradiol, and they are used by my practice to stop this conversion to increase the effectiveness of testosterone without side effects. Arimidex is the name of the drug and it was created to treat Pre-Breast cancer and to prevent breast cancer recurrence. Now we have an answer to treat endometriosis without putting patients through menopause which causes osteopenia.
If we have the ability to stop patients from losing their ovaries at a young age and decrease the morbidity of endometriosis, then fertility will be less of an issue in these patients and they will not need HRT as early.