Hello,
You may have already found out in the course your earlier consultations and personal research that this indeed is a difficult condition to cope with and manage. The treatment options also depend to an extent on the age, main symptoms, preferred treatment outcomes and side effects.
Looking at the information you have given here - I believe that
fertility and conceiving are not a priority for you at present. Managing the pain with hormones and pain killers is standard first line of management. The best hormonal option is a matter of trying and changing to find the one that suits best with regards to symptom relief and side effects.
It appears that combined
oral pills (Yasmin) and cerazette both were effective in relieving pain but caused unacceptable side effects. Our option then may be to consider an alternative method of combined pill or
progesterone only method. You could try a different pill to Yasmin, albeit of the same broad group go combined pills. You could take the pill free break of 7 days after using three packets. Hopefully the side effect on mood with a different pill will not be as significant. Some times the hormonal influence on mood can be modulated with lifestyle changes,
aerobic exercise, diet and mindfulness practices.
Another option might be to use Mirena coil, if you are agreed to it. It releases small amounts of progesterone within the womb and side effects like acne might be less. It can however cause light and irregular bleeding in initial 6-9 months. Period may stop completely. The device will need to be changed every 5 years until
menopause sets in, when declining natural hormones result in the
endometriosis deposits to shrink and become inactive over time.
This is my initial advice. Usually, it takes a trial of 6 months to assess if a hormonal method is working adequately. Remember all methods have some give and take - there may be trade offs between the relief of pain due to endometriosis and side effects of the hormones. So the expectation of treatment outcomes may need to be modulated and a balance struck.
I would strongly recommend to see a gynaecologist who specialises in endometriosis. Other options are available if the hormonal methods do not work for you or your priorities regarding treatment options changes for example if pregnancy becomes a desired goal.
Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Sabina Hussain,
OBGYN, Gynecological Oncology