Maria Sophocles, MD: Non-Invasive Options for Endometriosis

The painful symptoms of endometriosis require obstetricians and physicians be equipped with better non-invasive measures to aid patients. In an interview with MD Magazine®, Maria Sophocoles, MD, medical director of Women's Healthcare of Princeton, explained the pathology of endometriosis and how its resulting effects on women require improved measures of care.

MD Mag: What non-invasive treatments are available for endometriosis?

Sophocles: So, endometriosis is another one of the burdens that wreaks havoc on the daily lives of reproductive-age women. Endometriosis is harder for people to understand, harder for non OB/GYN clinicians to really get a handle on.

But an easy way to think of endometriosis, an easy way to explain it to your patient, is really one of the theories of how it happens—called a retrograde menstruation. When women grow endometrial tissue, it's really to host an embryo. And when they don't get pregnant in any cycle, the body doesn't need that endometrium, and sheds it. And that shedding of the endometrium is menstruation.

But we know now that for many women, some of the endometrial tissue enters the fallopian tubes and then is extruded out into the peritoneal cavity, and those endometrial cells implant on ovaries, on peritoneal surfaces, even distantly into the lung, the eye, other places. And they can grow cyclically, fed by estrogen.

Like fibroids, endometriosis is a large burden of pathology for American women, in terms of days of lost work and school pain, undiagnosed pain, infertility. And so, it's important that we try to treat it. It's been treated medically, it's still treated medically and surgically, but the focus is now on medical treatment, on non-invasive treatment suppressing the endometrial implants. So GnRH agonists, which have been used to shrink fibers, have also been used to shrink endometrial implants by reducing estrogen—in effect putting women in a menopausal state.

Unfortunately that comes with some side effects, like hot flashes and with long-term use, decrease in bone mass. So GnRH agonists have been the mainstay of endometriosis medical therapy. Combination oral contraceptives as well are inexpensive easy to use, and really are actually the first line of treatment for medical therapy for endometriosis.

There are other treatments in the pipeline, and I think over the next few years we're going to see other players available to physicians for medical therapy. But as far as FDA-approved, tried-and-true uses, clinicians should still use combination oral contraceptives as their first line of therapy, and then for patients who don't respond to that, GnRH agonists for endometriosis.