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ASK Endometriosis New Discoveries; No Surgery:

Could I Have Endometriosis?

If you have severe menstrual pain that occurs up to 10 days before and up to 7 days after your menstrual cycle begins, you could have endometriosis. If you have been trying to get pregnant and have been unsuccessful, you could have endometriosis. Since endometriosis can cause severe stomach cramps, diarrhea, nausea, headache and keep you from school or work, endometriosis is a common differential in young reproductive age women.

How Much Pain Must I Endure?
If the pain responds to Motrin®, Alleve® or Naprosyn® in doses up to 1600mg daily, and school or work is not interrupted, the disease process is considered mild. If addition of the oral contraceptive is also effective, somewhat, the disease is considered mild. But if there is infertility, loss of work, interruption of normal daily activities, the disease is not mild and must be investigated.

Subcategories of investigative Methods:
1. The doctor performs a pelvic and bimanual examination to determine whether there is a site or cause for the pain. This might include an ovarian cyst, a benign fibroid tumor or an unexpected pregnancy.

2. The doctor may perform or order an ultrasound to better determine what are the shapes and locations of the woman's internal structures.

3. If medication listed above fails to improve the pain and symptoms, the doctor may schedule a laparosopy. This is an out-patient surgical procedure at which time pictures are taken to determine if endometriosis or another pathological state exists. Lasers can be used to try to destroy endometriosis, adhesions, and cut out ovarian cysts.

4. If endometriosis is discovered, a potent and expensive medication called Lupron®/Lupolide Acetate can be prescribed for 5-12 months. Some doctors add-back estradiol patches to minimize these extreme side-effects. Lupron® creates a complete menopausal state, drying up the endometriosis and may cause significant bone thinning.

Observations of The Cochrane Group:
5.Endometriosis and GnRH agonists?
6. Danazol for pelvic pain associated with endometriosis.

5. Endometriosis and GnRH agonists?
Cochrane Menstrual Disorders and Subfertility Group 20 Oct 2003. DOI:10.1002/14651858.CD001297

Summary: Endometriosis is a painful condition caused where tissue from the lining of the uterus (womb) is outside the uterus as well. It can be treated with gonadotrophin-releasing hormone analogues (GnRHa). Possible adverse effects of GnRHas include loss of bone density, loss of sex-drive and hot flushes. The decrease in bone density is particularly important because it increases the risk of osteoporosis. The review found that taking hormone replacement therapy with GnRHas can prevent this adverse effect. Danazol can also prevent loss of bone density, but adverse effects of danazol can include acne, weight gain and headaches.

6. Danazol for pelvic pain associated with endometriosis
Cochrane Menstrual Disorders and Subfertilty Group 17 Oct 2007. DOI: 10.1002/14651858.CD000068.pub2

Summary:Treatment with danazol (including adjunctive to surgical therapy) was effective in relieving painful symptoms related to endometriosis when compared to placebo. Laparoscopic scores were improved with danazol treatment (including as adjunctive therapy) when compared with either placebo or no treatment. Side effects were more commonly reported in those patients receiving danazol than for placebo.

[Editor] Medical Breakthrough
More than 50 years ago, a weak androgen, Danocrine®/danazol was the only effective medication for treating endometriosis. The problem was that as the dose increased from 200 mg to 800mg per day the symptoms of hot flushes, acne and facial hair increased. While two-thirds tolerated 300-400mg daily, only 15% could tolerate 800mg. Danazol® reduced the bleeding and pain dramatically, increased muscle mass and could treat the pre-menstrual symptoms and pre-menstrual migraine. If fell out of use as the new allure of Lupron® gained favor, before the major complications of Lupron® became apparent. Many older gynecologists still prefer Danazol® to Lupron® and continue their patients on therapy for even years.
   What Danazol® does is two fold: 1)the drug acts as a testosterone and blocks the A-R estrogen receptors so the endometrium (uterine bleeding) and the endometriosis do not grow. Secondarily, 2) it reduces Sex Hormone Binding Globulin which strengthens the bonding of the danazol to the receptor: i.e., makes the drug up to four (4) times more potent over time.

With this 40 year knowledge, the Editor combined two anabolic steroids to repeat the process: a non-testosterone to lower the estradiol level even lower than Lupron® and a drug to block the receptors even more. The testosterone drugs prevent menopause hot flashes, yet, there are no menstrual periods and the endometriosis and even moderate fibroid (leiomyomata0 'dry up.' Symptoms of hirsuitism are avoided with spirolactone. Patients have been on this regiment for more than 30 years without any side-effects: except no menses, migraines, PMS, maintained muscle and bone and for two women-- no catamenial seizures (seizures related to the menstrual cycle.

The cost of this medication is less than $1000 per year; Lupron costs more than $10,000.

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