Women who suffer from endometriosis now have another drug to turn to in their struggle to manage the condition. A new pill, Visanne, has been designed to tackle the problem differently from conventional hormonal medicine. Whereas the latter prevents the ovaries from producing estrogen - and gives women menopausal side effects as a result - the new drug does not block the production of estrogen.
'This new medicine takes a completely different approach. It blocks ovulation, thus lowering the chances of endometriosis, but it does not block estrogen,' explains Thomas Strowitzki, director of the Department of Gynaecological Endocrinology and Reproductive Medicine at the University of Heidelberg, Germany.
Conventional GnRH (Gonadotropin-Releasing Hormone) analogue drugs put women in a menopausal state for the duration of the treatment. They block the pituitary gland, which stops estrogen production, thus relieving the pain associated with endometriosis. Women are put on this treatment for up to a maximum 12-month course.
Side effects from the resulting low levels of estrogen, however, are common, and most women will experience at least one or two symptoms commonly associated with the menopause. These include insomnia, headaches, mood swings, acne, dizziness, depression, decreased libido and vaginal dryness, although they usually disappear soon after conventional GnRH treatment ends.
Endometriosis is a condition in which the cells of the womb lining (the endometrium) are found outside the womb, usually in the pelvis and around the womb, ovaries and fallopian tubes. Unlike endometrial cells that are normally found in the uterus and which are shed during menstruation, those that grow outside the uterus remain in place and are stimulated during each menstrual cycle. Over the long term, this process gives rise to pain and can also result in scars or lesions on the tubes, ovaries, and surrounding structures in the pelvis.
Left undiagnosed or untreated, endometriosis can be a frustrating condition. Painful periods can cause a woman to miss work or school, strain sexual relationships, and affect the overall quality of her life. Besides irregular bleeding, endometriosis can also be a cause of infertility.
Dr Strowitzki says that doctors don't know why 15 per cent of fertile women develop endometriosis. 'To be honest, we don't know the risk factors and we don't know which group of women is at risk. We also don't know how to avoid the disease as it's not like cancer,' he adds.
In about 40 per cent of the sufferers, the lesions go away by themselves.
The benefit of Visanne is that apart from not having menopausal side effects, it can also be used for long-term treatment and not be limited to six- or 12- month courses. 'Women have normal estrogen levels and no hot flushes, but it is equally effective on the disease itself,' says Dr Strowitzki.
Visanne, made from synthetic progestin, was introduced in May last year. In places like Germany, progestin has long been taken as a form of oral contraceptive. Visanne, however, wasn't created as an oral contraceptive. It also has an anti-acne effect on skin, whereas 'other progestins typically cause acne', says Dr Strowitzki.
The main difference between progestin used as an oral contraceptive, and as a drug to treat endometriosis, is that the oral contraceptives only cover the symptoms of the condition instead of curing the underlying disease.
Women who take birth control pills in their 20s may thus not be aware that they have endometriosis as the pills also control the pain associated with the condition. So it may not be until they are in their 30s that they find out that they have endometriosis and that it is interfering with their fertility.
According to Dr Strowitzki, Visanne could well become the gold standard for the long-term treatment of endometriosis. As it is, a lot of women are reluctant to go for conventional GnRH treatment because of its menopausal side effects, which some find quite intolerable. 'Women don't like an invasive hormone treatment if they don't need it,' Dr Strowitzki points out.
'We have one study showing the reduction of endometriosis lesions with Visanne. This reduction of lesions may improve fertility later on,' he says, although during the time that the drug is being taken, fertility is lowered as ovulation is suppressed.
Can Visanne be used for birth control? 'Visanne is not in the market as an oral contraceptive,' cautions Dr Strowitzki. 'So we can't recommend it as a birth control pill even though we know it blocks ovulation.'
Surgery for endometriosis is an extreme measure, and there is no guarantee that women suffering from severe endometriosis can be completely cured by surgery. Supportive medical treatment is thus needed to manage the condition and make it less painful.
This article was first published in The Business Times.