Disease and Pharmacological Treatment Endometriosis - Term Paper Example

Endometriosis Name Institution Endometriosis Introduction Endometriosis is a female reproductive system illness in which the endometrial tissues, the cells that grow normally in the uterus only, appears and grow abnormally outside the uterus[Sus131]. Generally in the uterus, endometrium thickens in preparation for the embryo. When fertilization or pregnancy does not take place, there is shedding off of the extra lining that breaks down during the menstruation period. The endometrial cells or tissues that abnormally implant outside the uterus respond to the hormones in the body in the same way as inside the uterus. This means that when someone has endometriosis condition, the endometrial tissues that have grown outside the uterus will thicken, break down and bleed but will not be expelled vaginally like the normal endometrial tissues inside the uterus[Sus131]. Therefore, the implants build up and forms patches, cysts, scar tissue and adhesions over time. This abnormal growth of the endometrial cells is sometime extended to the fallopian tubes, ovaries and the other nearby organs at the pelvic region. This result to a severe abdominal pain, infertility, painful sexual intercourse, painful menstrual cramps, blood in the urine, heavy menstrual periods, bladder associated problems, and constipation and diarrhea to some women (Schweppe et al., 2013). Endometriosis is common in women of 25 to 40 ages and also could be found in teen years but only starts after the beginning of the menstruation periods. It occurs mostly in reproductive years where 50% of the women with infertility have this condition[Sus131]. The main aim for treatment of the endometriosis is to remove the implants that have resulted from the abnormal endometrial tissues that are responsible for endometriosis symptoms. The treatment will depend on the following; severity of the disease, pain, age, severity of the symptoms and whether one is willing to conceive in the future (Crosignani et al., 2006; Vercelline et al., 2009). The common pharmacological options are pain medications, hormone therapy and the last option is the surgery (Aliawadi et al., 2004). In pain medication, the patient is advised to take over the counter pain relievers like non-steroidal anti-inflammatory drugs which help to ease the painful menstrual cramps. Hormone therapy is where the supplemental hormones that reduce or eliminate the pain, slow down the growth and prevent any further implants of the abnormal endometrial cells. There are many hormonal therapies that are used in the treatment that include the hormonal contraceptives, Gonadotropin-releasing hormone (Gn-RH) agonists and the antagonists, progestin therapy and Danazol[Ame08]. Lastly, the surgery is the last option that a victim can take. This paper will discuss in details the treatment of endometriosis using progestin therapy pharmacological option. Progestin Therapy Treatment of the Endometriosis In 1950s, progestin was reported to have effect that could suppress the endometrium related symptoms (Vercelline et al., 2009). This led it to be used in the treatment of the endometriosis. Progestin hormone therapy is the second pharmacological option in the treatment of the endometriosis disease in women. Hormone therapies work by blocking the actions of the hormones to stop the endometrial cells implants from growing. For more than 40 years, oral progestins without estrogen component have been effectively used in the treatment (Reed et al., 2009; Crosignani et al., 2006). Progestins are drugs that behave in the same way like the natural female progesterone hormone. Progestins works by suppressing the growth or implants of the endometrial tissues and also in the pelvic cavity, they reduce the endometriosis-induced inflammations. In addition, progestins prevent the ovulation by blocking the luteinizing hormone (LH), provide pain relief and change the lining of uterus which eventually decreases (Chaudhry & Asselin, 2009). The treatment of endometriosis has been effective using different substances; derivatives of progesterone such as medroxyprogesteron acetate and dydrogesterone, and derivatives of C19-nortestosterone such as dienogest, desogestel, lynestrenol and norethisterone (Kokka et al., 2010). These substances only differ in their profile and strength of the action on the metabolic processes, hypothalamic-pituitary axis, genital organs and breast tissue (Kokka et al., 2010). Progestins have been successfully used in the treatment of endometriosis when combined with low-dosed estrogen or when alone depending on the severity of the symptoms. Progestin reduces the synthesis of the progestin receptors and thus, slows down the growth of implants of endometrial cells. When progestin is administered to the patient, more than 80% of the endometriosis symptoms are suppressed and hence the victim is relieved from symptoms pain and the growth of the implants is greatly reduced (Aliawadi et al., 2004; Reed et al., 2009). There are various forms of progestins that include the intrauterine device, injection and pill (Dai et al., 2005). In the intrauterine device, the levonorgestrel-releasing intrauterine system is used in treatment of heavy menstrual bleeding that helps to control the minimal and moderate endometriosis. In injection form, medroxyprogesterone is administered through injection for every three months. Pills are the oral progestins such as the norethindrone; micronor, Norlutate and Aygestin (Dai et al., 2005). Progestin can be effective in the treatment of endometriosis symptoms with a low dosage of 5 to 20mg per day (Reed et al., 2009). Recently, there has been a new dosage of 2mg/d of the newly approved dienogest since most of the progestins used in the treatment of endometriosis have been out of market in Germany such as hynestrenol, norethisterone acetate and medrogestone (Reed et al., 2009). Dienogest greatly reduces the progression and development of the endometriosis cells implants and also inhibits the proliferation of the endometrial stromal tissues or cells. Other substance like 100 to 200mg of the medroxyprogesterone have been tested and found to have an effective suppression of the endometriosis symptoms, but their suppressive effects might last for months or years after the treatment and hence, they are only recommended to women who are old and to those who are wishing not to conceive again (Chaudhry & Asselin, 2009). Study have shown that progestin have more than 85% inhibition of the ovulation to the user after a few months once the treatment has been introduced (Reed et al., 2009). Once the dosage is applied to most women, they stop their menstruation and ovulation during this treatment. In the first 3 to 6 months, most women will experience some spotting with some having prolonged or heavy bleeding. After 6 months most of the victims will have very light periods while some women will not have periods at all. Menstruation and ovulation resumes after 4 to 6 weeks when the treatment is stopped. The women who have medroxyprogesterone depot will only start menstruating and ovulating once the drug is completely removed from the body. The time this will take depends on the amount of the dosage that was used during the treatment and how fast her body metabolises the drug. Therefore, it is the most preferred option for the woman who would wish to conceive after the treatment (Crosignani et al., 2006). Progestins have direct effects on the endometrium which causes the atrophy and decidualization of both the endometriotic lesions and entropic endometrium (Kokka et al., 2010). This has benefited the patient who is using the progestins in the treatment of the endometriosis. Small placebo-controlled trials of the progestins have also been reported to have significant relief of the endometrial associated pain. Progestin offer a great benefit when treating a patient who has under gone a surgery in the treatment of the endometriosis since it reduces the probability of the pain recurrence and also lengthening the period in which the patient will be free from the endometriosis symptoms. Progestin is an appropriate alternative for the treatment of the endometriosis since most of its side effects can be tolerated by the patient and has less metabolic impacts and hence, the patient can carry on with her life as usual. It also reduces the patient’s frustrations contrary to the repeated surgical procedures that lead to increased pain after the operation (Reed et al., 2009; Kokka et al., 2010). Additionally, these repeated procedures lead to poorly tolerated effects and also contributes to the poor quality of the victim’s life. Research has shown that some of the women who undergo surgical procedures in the treatment of the endometriosis disease have more adverse effects compared to those treated using the progestin therapy (Reed et al., 2009). A major challenge in treating endometriosis is that, its symptoms recur after the treatment is terminated. There is very few studies published about the recurrence rate of endometriosis symptoms after the progestin therapy, but most of these symptoms occur again after the treatment and hence, it is vital for the patient to have a follow-up with a long-term medication since progestin does not eradicate all the implants or cysts (Chaudhry & Asselin, 2009). For long term solution and management of the endometriosis symptoms pain, progestin may be the most appropriate alternative due to its safety, cost and tolerability. Progestins are readily available and in various forms. Progestins also improve the quality of life of the patient during the first six months of the progestin therapy treatment of the endometriosis. In addition, there is provision of more newer and convenient routes for administration of the progestins to the women with endometriosis disease (Crosignani et al., 2006). There are few side effects that are caused by progestin therapy treatment of the endometriosis. They include changes in the uterine bleeding, weight gain, swelling in the ankles, face and feet, breast tenderness, headaches, nausea or vomiting, mood changes, decreased sex drives, changes in the eyesight and dizziness (Reed et al., 2009; Kokka et al., 2010; Chaudhry & Asselin, 2009; Dai et al., 2005; Schweppe et al., 2013). However, most of these side effects are brought by high dosage of the progestin during the treatment process. Conclusion Endometriosis is a chronic disease that causes the painful symptoms such as severe abdominal pain, infertility, painful sexual intercourse, painful menstrual cramps with blood in the urine, heavy menstrual periods, and bladder associated problems and thus, it requires a long-life management plan with a goal of maximizing use of the medical treatment and the avoidance of the repeated surgical procedure. There are many pharmacological options used in the treatment of the endometriosis that include the pain medications, hormone therapy and surgery. Progestin therapy uses the progestin which is the same as the natural hormone progesterone in the treatment of the symptoms of the endometriosis disease. Progestin works by stopping the growth of the endometrium and also the growth of endometriosis cells in other parts of the body. Progestin is the most preferred alternative for treatment of the endometriosis due to its safety, cost, tolerability, readily available in various forms, have significant relief of symptoms pain, limited and little metabolic side effects, and improves the quality of life more than other methods of treating the endometriosis. However, high dosage of progestin can lead to light or vaginal bleeding, weight gain, depression moods swelling in the ankles, face and feet, breast tenderness, headaches, nausea or vomiting, mood changes, decreased sex drives, changes in the eyesight and dizziness. Finally, further studies are needed to clarify the duration of the treatment, dosage required for the treatment, the type of the progestin to be used, the effectiveness of the endometriosis reduction and the effect of combining progestin with other drugs in the process of the treatment. References Sus131: , (Storck, 2013), Ame08: , (American Society for Reproductive Medicine, 2008), Read More