"Did You know?"

Tips and Information on Endometriosis: A Monthly Feature

Andrew S. Cook, M.D.
OBGYN.net Editorial Advisor
Endometriosis Advisory Board Member
Laparoscopy & Hysteroscopy
Hysterectomy and Alternatives
Chronic Pelvic Pain

Essay: Is There a Cure for Endometriosis?

Pelvic Pain and Endometriosis are complex diseases that are associated with a lot of misunderstanding, and, all too often, ineffective treatment. Unfortunately, too many patients are invalidated in the process of trying to receive treatment for their condition. In many cases, what in reality is a very treatable condition becomes a chronic medical problem due to inadequate treatment.

Currently, some of the most widely used techniques can be ineffective. Indeed, there is quite a disparity in both surgical and medical treatments used by physicians. There are those who believe that patients should be treated medically with GnRH agonists, such as Lupron, to place the patient in state of menopause. Some physicians even believe that patients should not or do not need to go through laparoscopic diagnosis of endometriosis prior to starting this treatment. Many believe in cauterizing or burning the endometriosis at surgery. Some of these surgeons will use specific drugs (like GnRH agonists) after surgery to get rid of any endometriosis that was left behind. Finally, many physicians who have devoted their practice to treating endometriosis patients use wide excision to remove the disease.

Patients are also hearing a wide range of opinions about outcomes and prognosis of endometriosis and pelvic pain. This includes everything from (1) surgery only provides temporary relief at best and will just result in multiple surgeries, thus it is an untreatable chronic condition that patients just have to learn to live with to (2) the opposite extreme: that endometriosis can be cured with the right type of surgery.

With all of this confusion and differing opinion, what are realistic expectations for a patient with endometriosis and pelvic pain? The short answer is that there are effective treatments for endometriosis and pelvic pain. Many patients do recover from these conditions and go on to lead a normal life with the proper multi-disciplinary approach.

To better answer the question “Is there a cure for endometriosis?” let’s look at breast cancer and its similarities with endometriosis. As of January 2006, the National Cancer Institute estimates that about 2.5 million women live with a history of endometriosis. It is estimated that there are approximately 5.5 million women in the U.S. with endometriosis. Both diseases affect a lot of women. More die from breast cancer, but we think that more suffer from pain and lose a functional life from endometriosis and pelvic pain.

According to the American Cancer Society, overall, the survival rates for women diagnosed with breast cancer are:
- 89% at five years after diagnosis
- 82% after 10 years
- 75% after 15 years

I think all physicians would agree that we do not have a “cure” for breast cancer. We have effective treatment and many patients will not have recurrence of breast cancer. But we cannot tell a breast cancer patient at the end of her treatment that she is cured. The majority of breast cancer cases are treated with surgery followed by either chemotherapy or radiation therapy in an attempt to eliminate any remaining cancer cells left behind at surgery.

Just as breast cancer has survival rates at 5, 10 and 15 years, a percentage of endometriosis patients will be disease free at 5, 10 and 15 years. Endometriosis can only be removed surgically. Unfortunately there is no chemotherapy for endometriosis. GnRH agonists do not eliminate or kill of endometriosis cells left after surgery.

Even though there is a high survival rate of breast cancer over five to fifteen years, there is no cure—just like there is no cure for endometriosis. Is there good, effective treatment for both diseases? Yes. Can we predict a solution with absolute certainty? In both cases, no. What we do know is that if both diseases are treated correctly, we lessen the chance of reoccurrence. And that largely depends on the skill of the surgeon, but it also depends upon other factors: genetics, overall health, age, nutrition and demographics, to name a few.

Both endometriosis and breast cancer require a comprehensive philosophical approach to treatment. What that means is that your doctor will spend the necessary time to talk with you about all aspects of your health first, including your nutrition and the nature of your pain, unlike the routine single-minded approach that is all too common in medicine.

Thus, while there is no guaranteed, 100% effective cure for endometriosis, we can say that there is effective treatment for endometriosis and, when treated appropriately, a significant number of women will regain their health and not experience this disease again.

Submitted by:

Andrew S. Cook, M.D, OBGYN.net Endometriosis Advisory Board Member
Reproductive Endocrinologist / Gynecologist
Medical Director / Founder
Vital Health Institute
http://www.vitalhealth.com/ 
Los Gatos, CA