How is Endometriosis Treated?
Currently, there are no treatment options to cure endometriosis. However, there are treatment options to relieve symptoms. These treatments may help reduce pain or promote fertility, among other outcomes.
Treatment options depend on your age, your symptoms, the severity of your condition, and whether or not you wish to have children. Your doctor will help you review all treatment options to determine what is right for you. Understanding the different options can help you play an active role in your care.
Medicines for endometriosis
Nonsteroidal anti-inflammatory drugs (NSAIDs) and hormone therapies are the most common drugs used to treat endometriosis-related symptoms. NSAIDs are often used as a first-line treatment for generalized pain, headaches, and inflammation. NSAIDs are often used to treat pain-causing conditions like endometriosis, osteoarthritis, psoriatic arthritis, rheumatoid arthritis, migraine, menstrual pain (dysmenorrhea), tendonitis, and dental-related issues.1
Hormone therapy drugs impact the levels of certain hormones in the body. Many hormone therapies suppress ovarian function in one way or another. This can prevent a person from ovulating (the process in which the body releases an egg each month). Ovulation can lead to a spike in various hormones, such as estrogen and progesterone. High levels of these hormones are often linked to the growth, thickening, and breakdown of endometriosis lesions. By stopping ovarian function and ovulation, the levels of these hormones can be stabilized. This may shrink endometriosis lesions and reduce pain.
Common examples of hormone therapy used to treat endometriosis-related symptoms and pain include:2,3
- Combination contraceptives like birth control pills, the vaginal ring (NuvaRing), and the skin patch contraceptive (Ortho Evra, Xulane)
- Progesterone-only contraceptives like progesterone-only birth control pills, the hormonal IUD (intrauterine device, Mirena), the birth control arm implant (Nexplanon), and the birth control shot Depo-Provera
- Gn-RH agonists and antagonists like Lupron, Lupaneta Pack, Zoladex, Synarel, and Orilissa
- Danocrine (danazol)
Surgical interventions for endometriosis may be recommended if other methods, such as pain medicines or hormone therapy, are not reducing symptoms like pain or infertility. Surgery can be risky and lead to life-altering side effects. This is why they are not the first line of treatment used for endometriosis. However, it is important to note that there is no cure for endometriosis at this time.
Even after surgery, endometriosis-related symptoms and pain may return. Fertility improvements made as a result of surgery may eventually decline again. It has been estimated that roughly 20 percent of those who have conservative endometriosis surgery experience symptoms again within 2 years. Around 40 percent or more may experience a return of symptoms within 5 years after surgery. Some experts suggest using hormone therapy along with surgery or after surgery to lessen the chance of symptoms recurring.4,5
Some common surgical procedures for endometriosis include:
Laparoscopic surgery is a minimally invasive procedure used to diagnose endometriosis. It is also used to remove endometriosis lesions or scar tissue. It is sometimes referred to as conservative surgery. 6
A laparotomy is a surgical procedure in which a large incision is made in the abdomen. This allows the doctor to view and address issues within the abdomen and pelvis. Laparotomies are not commonly performed at this time. Instead, most surgeons opt for laparoscopic surgery, if possible.7
A hysterectomy is a surgical procedure that involves removing the uterus. Some people with endometriosis have a hysterectomy after all other efforts to control pain and endometriosis-related symptoms have failed to provide relief. However, it is important to note that not even a complete hysterectomy can guarantee that endometriosis will never return.8
LUNA and PSN
Laparoscopic uterine nerve ablation (LUNA) and presacral neurectomy (PSN) work to relieve pain by destroying nerve fibers in the pelvis. The major difference between these procedures is which nerves they are targeting. Doctors believe that destroying certain nerve fibers in the pelvis may change how a person perceives pain. In turn, this may reduce overall levels of pain in the pelvis.9
When a person or couple is having difficulty becoming pregnant, they may need to see a fertility specialist or reproductive endocrinologist. Reproductive endocrinologists are gynecologists who specialize in the treatment of infertility. These doctors may run a variety of tests or take ultrasound images of your reproductive system to try to determine the cause of your infertility. They will also do the same for your partner.
Depending on the cause of your infertility, doctors may recommend fertility drugs designed to induce ovulation. They may also suggest lifestyle changes or other non-invasive treatment options. However, these options may not help induce pregnancy, and further interventions may be needed.
Assisted reproductive technology (ART) are procedures or treatment options designed to help a person become pregnant. They may be used when first-line treatment options have not led to pregnancy. They may also be used with a person or couple wanting to become pregnant needs access to donor sperm or eggs. Examples of ART include:10,11
- In vitro fertilization
- Third party-assisted ART, such as using a surrogate, gestational carrier, donor sperm, and/or donor eggs
- Intrauterine insemination, also called artificial insemination
In some cases, traditional treatment options may not manage your endometriosis symptoms as well as you had hoped. In other cases, treatment may be helping to manage your symptoms, but you may feel like lifestyle changes or at-home remedies may make them feel even better. In these cases, home remedies may help relieve symptoms and allow you to feel like your best self. Common home remedies for endometriosis include:
- Heat for relief from cramps
- Diet changes
It is important to note that home remedies are not meant to replace traditional treatment options. They are meant to be used along with your prescribed endometriosis therapy. Before trying any home remedy or making large lifestyle changes, it is important to talk to your doctor.
Complementary and alternative medicine
When a person is undergoing treatment prescribed by their doctor for their endometriosis, they are said to be under standard medical care. Treatment options used in combination with standard medical care that have been approved by a doctor are called complementary therapies or complementary medicine. In some cases, under a doctor's guidance and observation, a person may choose to use an alternative treatment option instead of standard medical care. This is referred to as alternative medicine.12
It is important to note that no complementary or alternative medicine methods should be used without the support and guidance of your doctor. Complementary and alternative medicinal practices that people with endometriosis may consider include: