"When actress and author Lena Dunham went public about having endometriosis https a disorder of the uterus she wanted to make something clear http The pain it causes can be completely debilitating and women desperately need better treatments.  Soon it seems women like Dunham with endometriosis pain will have a new option for relief. An endometriosis pain treatment was just approved by the Food and Drug Administration and its expected to arrive at pharmacies as soon as August https The pill called elagolix brand name Orilissa from the drugmaker AbbVie is the first FDAapproved oral treatment in more than a decade for the moderate to severe pain that comes with endometriosis. This medication could really be transformative said Hugh Taylor httpsmedicine.yale.eduobgynpeoplehugh_taylor.profile an OBGYN at Yale Medical School who led the key trials testing the drug.  Endometriosis is one of the most common gynecological conditions https affecting as many as one in  women httpendometriosis.orgresourcesarticlesfactsaboutendometriosis of reproductive age. And it can be incredibly painful. The reason is simple Women with the condition are growing excess tissue in their abdomen that they cant shed.  Every month a womans uterine lining thickens and sheds during her period if shes not pregnant. With endometriosis that tissue thickens and bleeds but it happens outside of the uterus  on the fallopian tubes or even in the nose http or lungs http Because the extra tissue has no way to exit the body it cant go through the vagina since its not growing in the uterus it builds up and becomes trapped leading to pain and in some cases infertility. Theres no cure for endometriosis. To manage symptoms women are usually prescribed birth control or overthecounter painkillers as a firstline approach but they dont always work. In severe cases a doctor may suggest excision surgery https to remove the extra tissue. Dunham had eight surgeries and ended up getting a hysterectomy https which was considered an extreme measure.  Enter elagolix. Endometriosis is an estrogendriven disease and the drug works by lowering estrogen levels. Two large doubleblind placebocontrol randomized trials https which  women completed tested whether it can help women control endometriosis pain. The results published last year in the New England Journal of Medicine https were impressive. The patients in those trials scored their pain from  no pain to  severe pain. On average they had pain levels of . out of  before starting on the drug  and they experienced a point reduction in pain after taking the treatment for three months. Its a major advance said Dr. Louis DePaolo head of the fertility and infertility branch at the National Institute of Child Health and Human Development and another option women have thats effective.  Now the less good news The drug wont cure endometriosis itll only tamp down the pain it causes. Many women in the trial experienced the symptoms of menopause  hot flashes headache insomnia  and researchers have also found the drug causes bone loss. We have no idea about the longterm effects of taking the drug because there are no trials lasting for longer than a year or how it stacks up against other painkillers since the trials only compared it to placebo. Thats not to mention cost The drugs price is listed at  per month. But for some the risks and costs may be worth it. Heres why.  Endometriosis is incredibly common  but it can go undiagnosed for years Endometriosis is a chronic sometimes highly disruptive condition. The three main ways it manifests are through pelvic pain infertility and pelvic masses such as cysts scar tissue and fibroids. According to the American College of Obstetricians and Gynecologists http some important signs of endometriosis include  Pain before and during periods  Pain during sex  Infertility  Fatigue  Painful urination during periods  Painful bowel movements during periods But many women dont know they have endometriosis. Its sometimes mistaken or dismissed for regular period pain. Definitively diagnosing the disorder requires invasive surgery doctors need to peer inside the pelvis through a laparoscopy. Imaging is rarely helpful in getting a clear diagnosis. This involves making a small incision in the belly and inserting a tube with a tiny camera to see if the pelvic organs show signs of tissue scarring and buildup. So its no surprise it takes between three and  years http_acognews_roommedianewsroommillionwomanmarchendometriosisfactsheet.pdf after the onset of symptoms to diagnose endometriosis.  Doctors arent sure why some women get it  Adding to the mystery around endometriosis No one knows exactly what causes it but doctors have some theories https  Retrograde menstrual flow During a period when a woman is shedding her uterine lining some of that tissue can flow through her fallopian tubes and into her pelvis which researchers think may cause endometriosis. But doctors have also found that the rate of retrograde menstruation https is about the same in women with and without endometriosis so they think additional factors spur the disorder in some.  Genes The disorder runs in families so doctors believe theres a genetic component https If a womans mom or sister had endometriosis the woman is believed to be at a higher risk.  Somatic mutations Researchers are also finding that somatic mutations https  acquired changes to DNA that happen after a person is born  may also be an endometriosis driver.   Immune system dysfunction Problems with the immune system can hamper a womans ability to clear her menstrual debris leading to endometriosis.  Environmental factors Theres some evidence to suggest environmental exposures to certain chemicals may contribute to ones risk of developing endometriosis. The treatments available dont always help and some have severe side effects When birth control pills or overthecounter painkillers fail to help endometriosis pain httpendometriosis.orgtreatments women are often left choosing between a monthly injection called Lupron Depot https which can put women into a profoundly menopausal state or Danazol httpendometriosis.orgtreatmentsdanazol a male hormone that often causes acne and facial hair growth. In women for whom these drugs arent effective or who dont want to take medications surgery to remove the displaced endometrial tissue can be a highly effective option https_link. But the trouble with surgery is that endometriosis can recur so women may need more surgeries. The success of surgery also depends on finding a skilled and experienced surgeon and theres always the risk of surgical complications.  The new drug elagolix is not riskfree either. In the trials women who took the drug had greater bone loss than did those who received placebo and this wasnt entirely surprising. Like other endometriosis treatments the drug works by lowering estrogen levels since endometriosis needs estrogen to grow. When that happens women experience menopausal side effects. The most common in the trials were hot flashes headaches and insomnia. Elagolix is available in two doses   mg per day or  mg twice daily  and the women on the higher dose experienced the side effects more frequently. Mood swings and night sweats were less common and one woman in the trial died by suicide though theres no indication that the medicine was a cause of her death.  DePaolo pointed out Elagolix doesnt have the pronounced side effects some of the other compounds have. Thats because he said it doesnt drive down estrogen levels as severely. But for patients who have tried other estrogenlowering medicines elagolix isnt all that appealing. This drug is palliative in nature. It does not cure or shrink the disease Casey Berna director of programs and partnerships for the advocacy group EndoWhat https The drugs side effects also concerned her as did the lack of knowledge about its longterm impact. For other women though the trade offs may be worth it. But in either case women with severe endometriosis are still left choosing between terrible pain surgery or drugs with serious side effects."