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You are here: Experts > Health/Fitness > Obstetrics/Gynecology > Endometriosis > possible endometriosis with pcos?
Endometriosis - possible endometriosis with pcos?
Expert: Martha Russell - 10/30/2009
Question
I have a question. Is it possible to have endometriosis and pcos together the only symptom I have with pcos is the cysts but I was reading on endometriosis and i have most of those symptoms as well. One docotor I saw said I do have endometriosis when he looked at my ultrasound and another one said I have pcos. I did get the conformation of the pcos with blood work now I would like to know if its possible to have endometriosis with pcos? I am constantly in pain all month everyday and i cannot take any pills except for aleve because I'm pretty much allergic to everything and Aleve doesnt even kill the pain
Answer
Treatment of PCOS and Endometriosis:
Medical treatment and management in PCOS is directed toward correcting metabolic irregularities, anovulation, hirsutism, and menstrual irregularity. For example, only after 4-12 weeks of dietary restriction and moderate exercising, patients with PCOS exhibited marked improvement in their endocrine and metabolic markers.
Metformin (Glucophage) is an antidiabetic medication that has been shown to improve insulin resistance and decrease hyperinsulinemia and cause an 8-fold increase in ovulation. (9)
Patients with PCOS who are infertile but desire pregnancy should be referred to a reproductive endocrinologist for further evaluation, workups and treatment of infertility.
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Oral Contraceptive Pills and Antiandrogens, such as Spironolactone, are effective for hirsutism in women who don't intend to get pregnant. Caution should be advocated in some cases and preparations that have Norgestrel and Levonorgestrel should be avoided because of their androgenic activity. (7)
In Endometriosis the pain initially is treated with a non-steroidal anti-inflammatory drug (NSAID), such as Ibuprofen (Motrin or Advil) or Naproxen sodium (Aleve).
Then in order to slow the growth of the endometrial tissue outside of the uterus and alter the hormone levels that promote endometriosis, or to lower the estrogen and androgen levels in the body Gonadotropin-Releasing Hormones(GnRH) or GnRH Agonists are used like Synarel, Lupron, Suprefact or Buserelin Acetate, Zoladex. GnRH agonists are stimulators of gonadotropin secretion and because of their action to turn off the ovary in terms of egg maturation they decrease the amount of circulating estrogen and slow down the growth of ectopic endometrium.
Another method that is used by doctors is to try and create a low estrogen and high androgen environment by achieving an anovulatory (no ovulation) state. Initially , this is achieved by using oral contraceptives and with progestational agents like Medroxyprogesterone(Provera), Ethinyl estradiol with progestins (Demulen, Ortho 1/35). Cyproterone acetate is a progestin that has antiandrogen activity and is used to treat hirsutism. This drug has not been approved for use in the United States but it is used in Europe as part of Oral Contraceptive Pills (OCP). Danazol (Danocrine or Cyclomen in Canada), is a drug, synthetic androgen, commonly used to treat endometriosis.
Gestrinone (Dimetriose, Florizel), is a weak progestin with strong anti-progesterone properties that inhibits gonadotrophin release and is also used to treat endometriosis. There are some adverse effects associated with the light androgenic activity of gestrinone but in most cases, the symptoms regress after completing the treatment. (10)
Danazol has been shown to be effective but because of the higher incidence of adverse effects always consult your doctor for risks of taking this medicine.
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