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Endometriosis | SexPharmD · Pharmacy Podcast Network

• 0:05
  Speaker 1: You are listening to the Global Network of Podcasters dedicated
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  Speaker 1: to the pharmacy profession. Welcome to the Pharmacy Podcast Network.
• 0:38
  Speaker 2: This is the Sex Pharm D podcast with your host, Dr.
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  Speaker 2: Nadia Archambault, licensed clinical pharmacist and certified sex therapist. With
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  Speaker 2: a focus on women's sexual health and wellness, Dr. A
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  Speaker 2: is here to cover important health topics and answer all
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  Speaker 2: of your questions about subjects that can be applied to
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  Speaker 2: pharmacy practice. And now, here's Dr. A.
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  Speaker 1: Hello and welcome to another episode of Sex Pharm D.
• 1:02
  Speaker 1: Thank you so much for tuning in. I wanted to
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  Speaker 1: do this episode because... I was absolutely crushed when Dolly
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  Speaker 1: Parton died. She was literally my favorite. And for those
• 1:12
  Speaker 1: of you that know me, you know she was my favorite.
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  Speaker 1: And she actually battled with something that I thought would
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  Speaker 1: be a good topic to talk about on this show.
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  Speaker 1: Since we talk about sexual health, women's sexual health and wellness.
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  Speaker 1: And so Dolly Parton actually had endometriosis, for those of
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  Speaker 1: you that did not know. It was actually four days
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  Speaker 1: before she died. It was August 21st. And she had
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  Speaker 1: said that she had been following a brief battle with cancer.
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  Speaker 1: She actually told people in her interview that she had
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  Speaker 1: had past gynecological problems. And this was actually endometriosis and
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  Speaker 1: endometriosis was often misdiagnosed or not diagnosed. Um, and I
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  Speaker 1: thought it was important to talk about. So she actually
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  Speaker 1: started talking about in her interview that, you know, she
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  Speaker 1: had this brief battle with cancer and she had been
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  Speaker 1: dealing with her grief over her late husband, Carl, and she,
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  Speaker 1: she wasn't paying attention to some health issues when she
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  Speaker 1: was helping to care for him when he was sick.
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  Speaker 1: But she said that this wasn't the first time she's
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  Speaker 1: had to manage something major in her life. And she
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  Speaker 1: said that in the early 80s, she was down, as
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  Speaker 1: she calls it, she was down for the count with
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  Speaker 1: some female issues she said she struggled with and she
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  Speaker 1: was struggling with her weight. And she actually had to
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  Speaker 1: cancel a tour due to severe abdominal pain and bleeding,
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  Speaker 1: which are common symptoms of the condition of endometriosis. And
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  Speaker 1: Dolly Parton actually underwent a partial hysterectomy. And I think
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  Speaker 1: a lot of people didn't know that. She kept her
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  Speaker 1: health issues very private because, of course, she wanted to
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  Speaker 1: be this bright light for everybody. And I really admired
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  Speaker 1: that about her. And she also talked about how she
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  Speaker 1: never had children with her husband, Carl Dean, and that
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  Speaker 1: a lot of that infertility is from endometriosis. Endometriosis is
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  Speaker 1: the leading cause of female infertility. Uh, so she talked
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  Speaker 1: about that in her interview and I, I thought it
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  Speaker 1: would be a good topic to talk about and just
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  Speaker 1: kind of break down what endometriosis is. I know some
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  Speaker 1: people already know what it is, uh, but there's a
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  Speaker 1: lot of, of myths about it. There's still a lot
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  Speaker 1: that people are trying to, uh, figure out about endometriosis.
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  Speaker 1: And even to this day, I see patients who often
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  Speaker 1: have it, um, just misdiagnosed and it takes years to
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  Speaker 1: get a diagnosis. So endometriosis is a medical condition where
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  Speaker 1: the tissue, similar to the lining of the uterus, grows
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  Speaker 1: outside of it. And most often it grows on the
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  Speaker 1: pelvic organs. So this can cause pelvic pain, which is
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  Speaker 1: severe cramping or pain during menstrual periods that can be
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  Speaker 1: worse than what normal cramping and pain are. are. Pain
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  Speaker 1: with sex. So you have a very deep discomfort during
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  Speaker 1: or after. A lot of women I've talked to who
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  Speaker 1: have it get intense abdominal pain and cramping after having sex,
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  Speaker 1: which is not pleasant at all. Digestive issues, anything from bloating, nausea, diarrhea, constipation,
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  Speaker 1: especially during times of their menstrual cycle. It can cause infertility,
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  Speaker 1: difficulty getting pregnant and urinary or bowel pain. Again, mostly
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  Speaker 1: during menstrual cycle. There's a lot of unknown causes for this.
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  Speaker 1: They're still trying to figure out, experts are still trying
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  Speaker 1: to figure out the triggers. They think that what's happening
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  Speaker 1: is it's called retrograde menstruation where the menstrual blood flows
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  Speaker 1: backwards into the pelvis. They're looking at immune system issues,
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  Speaker 1: immune system dysregulation, and then, of course, family history. If
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  Speaker 1: the woman has had a mom or a sister or
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  Speaker 1: an aunt, that can increase the risk. So if you're
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  Speaker 1: experiencing symptoms like this, they'll often look at symptom history,
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  Speaker 1: physical exams. They do an ultrasound or MRI. Definitive diagnosis,
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  Speaker 1: it's usually a minimally invasive surgery. It's called laparoscopic surgery.
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  Speaker 1: Sometimes they can just confirm it with an ultrasound or MRI.
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  Speaker 1: And unfortunately, there's no cure for this. It really is
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  Speaker 1: just pain management. Sometimes hormone therapy helps some women. If
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  Speaker 1: it's really bad, they have to do surgical removal of
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  Speaker 1: the tissue. And then if a woman is trying to
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  Speaker 1: have children, they'll try to remove that abnormal tissue as
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  Speaker 1: much as possible to improve the fertility. As for pain management,
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  Speaker 1: Anti-inflammatories like your ibuprofen and naproxen to help minimize the inflammation,
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  Speaker 1: help with menstrual cramps. There are some prescription options that
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  Speaker 1: are a little stronger for severe pain. So a provider
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  Speaker 1: may prescribe naproxen. a stronger anti-inflammatory or pain med. For
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  Speaker 1: some women, hormone therapy helps manage symptoms. So the hormone therapy,
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  Speaker 1: the goal of that is to lower your estrogen or
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  Speaker 1: stop your menstrual cycle entirely to slow down that tissue growth.
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  Speaker 1: It's an endometrial-like tissue, which will grow more during the
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  Speaker 1: menstrual cycle. So some women go on birth control pills,
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  Speaker 1: so the oral contraceptives. It can be a patch. They
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  Speaker 1: can do vaginal rings. Sometimes they do progesterone-only options, the IUDs,
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  Speaker 1: and that will help to lighten, make the periods less
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  Speaker 1: painful or stop them altogether so then you don't have
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  Speaker 1: to deal with it at all. And then... There is
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  Speaker 1: an injectable. It's called Lupron. It's a GNRH analog. Then
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  Speaker 1: there's Oralisa, which is another one. It's called an oral antagonist.
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  Speaker 1: So what that does is it suppresses the ovarian function
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  Speaker 1: to basically stop or put a pause on the menstrual
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  Speaker 1: cycle to give the body some relief. And then... Another
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  Speaker 1: one is called Yetzli. I think I'm mispronouncing that. Orlis
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  Speaker 1: is the one that people have heard of that's been
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  Speaker 1: out there. And then what they do with that one
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  Speaker 1: is they put it with a low-dose hormone. And then
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  Speaker 1: also bone density is... So when you're on these kinds
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  Speaker 1: of medications, it can decrease bone density. So something to
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  Speaker 1: help with the bone density issue. Another, a more aggressive
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  Speaker 1: form of treatment would be a surgery. So if these
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  Speaker 1: medical treatments are not working after like a six month period,
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  Speaker 1: or if there's some damage happening to the pelvic organs,
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  Speaker 1: because those tissues and lesions can happen on the organs
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  Speaker 1: in the pelvis, they do a laparoscopic surgery. That's more
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  Speaker 1: common where the physician will cut out and remove that
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  Speaker 1: abnormal tissue. They've done in the past before ablation to
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  Speaker 1: minimize the risk of the tissue returning. But in this case,
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  Speaker 1: they just try to remove it by cutting it out.
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  Speaker 1: And then you have hysterectomies. This is a last resort
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  Speaker 1: because If a female wants to have children, then having
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  Speaker 1: a hysterectomy gets basically your chances that are over after that.
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  Speaker 1: And then you have to go on a hormone therapy
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  Speaker 1: because it puts your body into early menopause. Again, not
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  Speaker 1: a horrible thing, but it, you know, and it is
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  Speaker 1: an option and some women do have to have that as,
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  Speaker 1: you know, as a last resort. And I wanted to
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  Speaker 1: break down the hysterectomies because there is actually two types
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  Speaker 1: of hysterectomies. There's a partial and a full. So partial
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  Speaker 1: hysterectomy removes that main part of the womb where, and
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  Speaker 1: you're still, but you're still leaving the cervix intact. And
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  Speaker 1: then depending on what it's looking like, Sometimes the provider
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  Speaker 1: will be able to leave the ovaries and fallopian tubes,
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  Speaker 1: but that depends on the need of the woman. And
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  Speaker 1: then full hysterectomy is everything. So they remove the uterus
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  Speaker 1: and cervix, and that's usually the most common part. So
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  Speaker 1: I wanted to break that down because some people aren't
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  Speaker 1: aware that there's two types of hysterectomies. You know, this
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  Speaker 1: is a last resort. Unfortunately for some women... This is
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  Speaker 1: the only option they have. And some people ask, well,
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  Speaker 1: can I still have children if I have a partial hysterectomy?
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  Speaker 1: So basically, the ovaries are still left in place. You
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  Speaker 1: can still ovulate and produce hormones, even though you do
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  Speaker 1: not have a menstrual period anymore. But because that main
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  Speaker 1: part of the uterus is gone, the fertilized egg can't
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  Speaker 1: implant and grow into a normal pregnancy. So it can
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  Speaker 1: actually be very dangerous. If the pregnancy does happen, it
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  Speaker 1: can result in what's called an ectopic pregnancy in which
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  Speaker 1: it'd have to be surgically removed. But some people opt
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  Speaker 1: for the partial because then they're still producing their normal
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  Speaker 1: estrogen and progesterone hormones. So then they don't have to
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  Speaker 1: go on hormone therapy. So that's the difference. So partial,
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  Speaker 1: you don't necessarily have to go on hormone therapy because
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  Speaker 1: you're still creating those hormones, producing them. Full hysterectomy, it
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  Speaker 1: puts your body into full menopause. So you have to
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  Speaker 1: go on your estrogen. You don't need progesterone necessarily when
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  Speaker 1: you have a full hysterectomy. because you don't have to
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  Speaker 1: worry about that lining of the uterus thickening. So some
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  Speaker 1: women don't know this, but if they have not had
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  Speaker 1: a hysterectomy and they're going on hormone replacement therapy, the
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  Speaker 1: estrogen has to be paired with progesterone unless you've had
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  Speaker 1: a hysterectomy. Because if not, that can cause thickening, uterine lining. Um,
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  Speaker 1: you have to be worried about cervical uterine cancer. It
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  Speaker 1: just puts you at more risk, but not if you've
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  Speaker 1: had a full hysterectomy. So those are the two, the,
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  Speaker 1: the two main ones. Um, there, there are resources out
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  Speaker 1: there for women as far as endometriosis goes. I still
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  Speaker 1: think we need to, we, we, we've come some way,
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  Speaker 1: but we still need to come a lot longer way. Um,
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  Speaker 1: There's the Endometriosis Foundation of America. I'll post that in
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  Speaker 1: my show notes. And, you know, this is a tough
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  Speaker 1: thing to deal with as a female. And, you know,
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  Speaker 1: I've treated patients, I've spoken with patients who are not
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  Speaker 1: able to have sex at all because they have endometriosis
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  Speaker 1: and or, you know, because it's just not enjoyable for
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  Speaker 1: them and they have pain afterwards. Um, and it can,
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  Speaker 1: it can be a lot. So this is something that
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  Speaker 1: I wanted to bring a little bit more awareness about. Um,
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  Speaker 1: some women who have endometriosis work with, um, pelvic floor specialists,
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  Speaker 1: physical therapists, occupational therapists. I did a great interview with Dr.
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  Speaker 1: Sarah Apple, who is a pelvic floor, um, therapist. And
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  Speaker 1: we both work with patients who have, um, endometriosis, and
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  Speaker 1: she helps them a lot. So this is an actual
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  Speaker 1: field of physical therapy and occupational therapy to help women.
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  Speaker 1: So there are resources out there. And I thought it
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  Speaker 1: was really great that Dolly Parton talked about this because
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  Speaker 1: she has a big reach for people. And it was
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  Speaker 1: very brave of her to talk about back in the eighties.
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  Speaker 1: I can only imagine what that was like, where they
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  Speaker 1: really did not have a lot of treatment options. Um,
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  Speaker 1: and a lot of people asked, you know, always wonder
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  Speaker 1: why she didn't have children. Well, that was probably why,
• 15:02
  Speaker 1: because it caused a lot of infertility issues. So thank you, Dolly.
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  Speaker 1: I loved her so much. Um, and this is an
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  Speaker 1: important topic, so I'm glad I have the platform here
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  Speaker 1: to talk about it. As far as the RX meter,
• 15:21
  Speaker 1: since we're talking about endometriosis, I wanted to use this
• 15:26
  Speaker 1: as an opportunity. So Oralisa, as I was earlier talking about,
• 15:31
  Speaker 1: the generic name is Elagolix. Maybe I'm mispronouncing that. Not sure.
• 15:37
  Speaker 1: I know as pharmacists, sometimes we just don't know if
• 15:40
  Speaker 1: we're pronouncing things correctly. So this is an FDA-approved prescription,
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  Speaker 1: and it's used to treat the moderate or severe pain,
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  Speaker 1: and that's related to endometriosis. It is not a painkiller.
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  Speaker 1: So it works, I mentioned it earlier, as a GNRH
• 16:01
  Speaker 1: receptor antagonist. Those are big words. So basically, what does
• 16:05
  Speaker 1: it do? It lowers estrogen levels in the body. Lowering
• 16:09
  Speaker 1: estrogen levels ultimately helps reduce that inflammation and pain caused
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  Speaker 1: by endometriosis, again, does not cure. Typical dosage, it comes
• 16:20
  Speaker 1: as a 150 milligram once daily, typically used for, they
• 16:25
  Speaker 1: actually use it for up to two years, so 24 months.
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  Speaker 1: There's a 200 milligram twice weekly, and that's used for
• 16:36
  Speaker 1: women who have pain during sex. So and they use
• 16:40
  Speaker 1: that for up to six months. Now, I'm not sure
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  Speaker 1: I like the side effects of this. So side effects
• 16:47
  Speaker 1: are it's almost like you have menopause, hot flashes and
• 16:51
  Speaker 1: night sweats, headaches and nausea. Some people, some women have
• 16:57
  Speaker 1: difficulty sleeping, mood changes. Now, it will sometimes cause reduction
• 17:04
  Speaker 1: in the menstrual cycle. There have been reports anxiety, depression.
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  Speaker 1: So I'm not sure if I'm liking that. And then this,
• 17:15
  Speaker 1: I'm not, I don't really like this side effect, but
• 17:19
  Speaker 1: you have to be really mindful of bone loss. It
• 17:21
  Speaker 1: causes a decrease in bone mineral density, and that may
• 17:27
  Speaker 1: not be completely reversible after stopping treatment. So you usually
• 17:34
  Speaker 1: have to pair it with a drug that helps with
• 17:38
  Speaker 1: bone density. And as we know, as women, once we
• 17:43
  Speaker 1: hit premenopause, menopause, your bone density starts getting lower and lower.
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  Speaker 1: So this is not necessarily a good thing, especially if
• 17:52
  Speaker 1: you're younger and you're on this, and that's when you
• 17:54
  Speaker 1: need all the bone density treatment. reserves you can get.
• 17:58
  Speaker 1: And then of course, another thing to be mindful of,
• 18:00
  Speaker 1: this is not a birth control. So that's a counseling
• 18:02
  Speaker 1: point there for patients. So obviously backup methods are needed.
• 18:07
  Speaker 1: And this is interesting too. Estrogen containing birth control can
• 18:11
  Speaker 1: make the oralisa less effective. And then contraindications, of course,
• 18:19
  Speaker 1: do not take it if you are pregnant. There's a
• 18:22
  Speaker 1: liver disease contraindication. As we know, a lot of medications
• 18:26
  Speaker 1: are processed through the liver. And then if you have
• 18:28
  Speaker 1: any issue with bone density, like if you already have
• 18:30
  Speaker 1: the predisposition or have some type of osteoporosis, would not
• 18:35
  Speaker 1: recommend that. So I don't know how I'm thinking about this. Again,
• 18:41
  Speaker 1: you have to look at risk versus benefit. If this
• 18:46
  Speaker 1: is really working for someone, then... It's worth a try.
• 18:51
  Speaker 1: I just don't like that. The big one I don't
• 18:54
  Speaker 1: like about it is the bone loss. So I'm going
• 18:59
  Speaker 1: to give, and I don't know the cost. So I'm
• 19:02
  Speaker 1: sure that there are plans like GoodRx. I know on
• 19:06
  Speaker 1: the drug website, they have a savings card on here
• 19:12
  Speaker 1: where you can pay as little for five a month.
• 19:14
  Speaker 1: I'm not sure. Of course, there's eligibility restrictions. And then also,
• 19:22
  Speaker 1: you have to worry about for how long that $ 5
• 19:26
  Speaker 1: a month, sometimes it's only like for the first three months.
• 19:30
  Speaker 1: And so, but there are copay assistance programs out there.
• 19:35
  Speaker 1: It's just a matter of for how long. The cash
• 19:42
  Speaker 1: price of this, it's a very, very expensive drug. It's
• 19:45
  Speaker 1: between about $ 1, 200 to $ 1, 600 a month. And that's for
• 19:51
  Speaker 1: 28 tablets. So that can be a month's supply of
• 19:55
  Speaker 1: the 150 milligram or for 56 tablets of the 200 milligram.
• 20:02
  Speaker 1: So I'm not sure about that. Again, risk versus benefit,
• 20:05
  Speaker 1: but I'm not liking that bone density loss. So I'm
• 20:09
  Speaker 1: going to give this a six. I do appreciate that
• 20:14
  Speaker 1: this is a non-pain, it's not a pain med. So again,
• 20:21
  Speaker 1: if you're on prescription pain meds, that can get addicting. Well,
• 20:25
  Speaker 1: your body develops a dependence to it. So then you
• 20:27
  Speaker 1: have to keep increasing dosages. So that is a good alternative,
• 20:31
  Speaker 1: but I'm not sure if I'm really loving this one.
• 20:34
  Speaker 1: So those are my thoughts on that. Thank you again
• 20:39
  Speaker 1: for listening. I have some other podcasts. I've talked about
• 20:42
  Speaker 1: some endometriosis before, and I will continue to talk about this.
• 20:49
  Speaker 1: I'm hoping to get some interviews of some professionals who
• 20:53
  Speaker 1: specialize in this and even some patients to talk. to
• 20:57
  Speaker 1: get their opinion on what their, and basically what their
• 21:01
  Speaker 1: journey's been like with endometriosis. So thank you all for
• 21:06
  Speaker 1: listening and until next time.