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Hope for Ending the Pain, Infertility of Endometriosis?

Jan Ruma’s pain was getting worse, but she wrote it off as just a part of growing older and a normal side-effect of “that time of the month// .”

“I was increasingly having painful menstrual periods, cramping, painful abdomen and lower back pain,” says Ruma, 43.

After running some tests, her doctor discovered that Ruma had endometriosis, a painful condition that affects one in 10 women, usually of childbearing age. In addition to painful menstrual periods, it can cause fertility problems, heavy bleeding, painful intercourse and appears to be associated with autoimmune disorders such as rheumatoid arthritis, lupus and thyroid disorders.

“Endometriosis, simply put, is when the lining of the uterus, or the womb, is located where it should not be: outside of the uterus,” says Dan Lebovic, M.D., M.A., assistant professor of obstetrics and gynecology at the University of Michigan Medical School, who is exploring new treatment options for women with endometriosis.

“The quality of life in patients with endometriosis is severely compromised. We see a lot of patients whose jobs have been jeopardized because they have to stay home on account of pain, sometimes up to two weeks at a time,” he notes.

Treatments for the condition include medications and surgery, says Lebovic, also the co-director of the U-M Health System Endometriosis Center. Physicians sometimes prescribe pain killers or oral contraceptives to diminish the woman’s period and therefore reduce her pain, and hormones that suppress ovarian function and therefore suppress the estrogen that “seems to feed these lesions,” he says.

Surgical options include a simple laparoscopy, a procedure with only small incisions that can be used to excise small lesions in cases of mild endometriosis. More severe cases may require a laparotomy, a surgery with a larger incision in the abdomen that may require many weeks to months of recovery time. Women who do not w ish to maintain their fertility occasionally resort to a hysterectomy, the full removal of the uterus and ovaries.

None of these options is perfect, Lebovic notes. In many cases, the treatment of the pain and heavy periods can lead to the end of a woman’s fertility. That’s why Lebovic and other U-M Health System researchers are exploring the possible use of the diabetes medication called rosiglitazone as a treatment for endometriosis.

The trial is in progress of recruiting participants with Stage I or II (minimal or mild) endometriosis, and there is no conclusive result yet, but Lebovic says the medication may help to decrease endometriosis patients’ pain and lesion size without making them infertile. “We are certainly hopeful this medicine will make a great impact on women with endometriosis,” Lebovic says.

Ruma is one of the participants in the trial. While it is too early to say definitively how the treatment will affect her, she says it has improved her health and reduced her symptoms in the six months she has been on the medication.

7 things to know about endometriosis

1.What it is: Endometriosis is a condition in which the lining of the uterus is located outside of the uterus.

2. Symptoms: Painful periods, heavy bleeding, painful intercourse and sometimes fertility problems. Some women also have chronic pain in the lower back and pelvis, as well as intestinal pain.

3. Diagnosis: A doctor will begin with a physical exam, including a pelvic exam, followed by ultrasound and/or magnetic resonance imaging (MRI). The only way to be certain that a person has endometriosis is through a surgery called laparoscopy, in which a small, lighted tube is used to see the uterus region.

4.Prevention: Endometriosis cannot be prevented.

5. Who is at risk: One in 10 women has endometriosis. Typically it occurs when a women is of childbearing age. Women have a five- or six-tim es greater chance of developing endometriosis if a family member has had it, and women who started their periods early may have a higher risk.

6. Treatment: Treatments can assist with the pain and fertility issues that arise with endometriosis. Pain medication, birth control pills or oral contraceptives, hormone therapy to suppress ovarian function, and surgery are some options. Several types of surgery can be performed, including laparoscopy (surgery with small incisions used to remove small lesions), laparotomy (a major abdominal surgery with a larger incision) or hysterectomy (removal of the uterus). There is no cure for endometriosis.

7. Possible treatment in the future: University of Michigan Health System researchers are conducting a clinical trial involving a medication called rosiglitazone, currently used to treat people with diabetes.

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