For the CPT patient, it is important to keep in mind that physicians will address your treatment with regard to their own medical specialty. Although CPT manifests itself as a thoracic problem, the underlying cause is hormone related and therefore needs to be addressed by your gynecologist as well. Successful treatment depends upon your gynecologist and thoracic surgeon/pulmonary specialist working together to address your treatment options.

Literature shows that many women are treated for SPT until a correlation is made between multiple lung collapses and the start of menses. A first incident of SPT may be treated with oxygen, observation and rest if the collapse is small. A medium to large collapse may require manual aspiration or a chest tube. A second occurrence may be treated more aggressively with a sclerosing agent or surgery to remove blebs.

Aspiration A catheter is inserted into the pleural space and the air is removed manually, allowing the lung to re-expand. Another version of this involves connecting the catheter to a one-way valve allowing air to escape passively (Heimlich valve).

Thoracostomy (Chest tube) A tube is inserted through the chest wall and into the pleural space. Generally, suction and a water seal are applied, removing the air and causing the lung to re-expand. This procedure requires pain medication and a hospital stay until re-expansion has occurred.

Chemical Sclerosis / Pleurodesis A chemical is introduced through the chest tube causing inflammation and scarring of the pleural surfaces. This promotes the formation of adhesions between the lung exterior and the chest wall, thereby discouraging future collapses. One important note: this procedure can be extremely painful.

If CPT is suspected, conservative non-surgical treatment includes endometrial suppression therapy using a variety of synthetic hormonal drugs (progestins). Note: There are significant risks and side effects associated with the use of progestins. Careful consultation with your physician is recommended before starting treatment with progestins.

GnRH Therapy Gonadotropin Releasing Hormone agonists suppress menstruation (chemically induced artificial menopause). Previously, these were generally used no longer than six months. Current use of these medications can now be much longer, and may involve add-back hormonal therapy.

Although not widely used, natural progesterone is gaining in popularity as a safer alternative to the synthetic progestins. Plant extracted progesterone is identical to the progesterone produced by the body, eliminating many of the serious side effects associated with synthetic hormonal drugs.

Aggressive treatment options include surgical procedures to remove endometrial implants, repair diaphragmatic fenestrations or abrade pleural surfaces to discourage future lung collapses.

Thoracoscopy / VATS - Video Assisted Thoracic Surgery Accessed through small incisions, this procedure utilizes a fiber optic scope to visualize the lung, pleura and diaphragm, so that the surgeon can find endometrial implants or holes in the diaphragm, and repair them. Bleb resection and pleurodesis can also be performed during VATS.

Thoracotomy In this procedure, an incision is made on the side of the chest, between the ribs. The ribs are spread apart, allowing the lung, pleura and diaphragm to be viewed visually by the surgeon. As in VATS, biopsy, bleb resection and pleurodesis can be performed. A pleurectomy can also be performed which involves removal of the pleura to encourage the lung to adhere directly with the chest wall.

Diaphragmatic Repair using Polymesh In this procedure, a Vicryl type mesh is placed over the diaphragm, to cover any smaller fenestrations (holes) that may not be seen by the surgeon. Although the Vicryl material is absorbed over time, the mesh allows for tissue ingrowth and the resulting scar tissue obliterates the diaphragm pores. As in other thoracic procedures, mechanical pleurodesis or pleural abrasion would also be done. This procedure can be performed during thoracotomy or thoracoscopy, and was first introduced in the literature in The Annuals of Thoracic Surgery in 2003. Since then, it has been performed with success in the United States, although the frequency is unknown. A second article from the UK in 2006, strongly advocates the use of the mesh in combination with GnRH therapy in order to successfully treat CPT.

Pleural Abrasion (Mechanical Pleurodesis) This type of pleurodesis involves abrading or "scrubbing" the pleural surfaces so that the resulting inflammation forms adhesions between the lung and chest wall, making it harder for the lung to collapse again if air should enter the pleural space. Sometimes talc is added to encourage adhesion formation.

Hysterectomy / Bilateral Salpingo-Oophorectomy In some cases the uterus and/or ovaries are removed to limit estrogen production and suppress endometrial tissue by inducing surgical menopause.