How is Endometriosis Treated?

Currently, there are no treatment options that exist to cure endometriosis, however, there are treatment options intended to provide symptom relief. These treatment options may help reduce pain or promote fertility, among other health outcomes. Selecting a treatment option will depending on an individual’s age, the symptoms she is experiencing, the severity of her condition, and whether or not she wishes to have children. Your healthcare provider will help you review all treatment options to determine the best course of care in your specific situation. Examples of common treatment options are outlined below.

Medications

The most common medications used to treat endometriosis-related symptoms include NSAIDs and hormone therapies. NSAIDs (nonsteroidal anti-inflammatory drugs) are often used as a first-line treatment for generalized pain, headaches, and inflammation. Examples of common pain-causing conditions that may benefit from using NSAIDs include, but are not limited to, endometriosis, osteoarthritis, psoriatic arthritis, rheumatoid arthritis, migraine, menstrual pain (dysmenorrhea), musculoskeletal sprains and strains, tendonitis, and dental-related issues.1

Another common class of medications used to help manage the symptoms of endometriosis are hormone altering drugs. These medications, often called hormone therapy, impact the levels of certain hormones in the body. Many hormone therapies suppress ovarian function in one way or another. This can prevent a woman from ovulating (the process by which she releases an egg each month). Ovulation can lead to a spike in various hormones, such as estrogen and progestin. These hormones, and their high levels, are often linked to the growth, thickening, and break down of endometriosis lesions. By suppressing ovarian function and ovulation, the levels of these hormones can be stabilized, potentially shrinking endometriosis lesions and reducing pain.

Common examples of hormone therapy used to treat endometriosis-related symptoms and pain include:

  • Combination contraceptives, including birth control pills, the vaginal ring (NuvaRing), and the skin patch contraceptive (Ortho Evra, Xulane)
  • Progestin-only contraceptives, including progestin-only birth control pills, the hormonal IUD (intrauterine device, Mirena), the birth control arm implant (Nexplanon), and the progestin injection (also referred to as the birth control shot, Depo-Provera)
  • Gn-RH agonists, including Lupron, Lupaneta Pack, Zoladex, and Synarel
  • Danocrine (danazol)2,3

Surgery

Surgical interventions for endometriosis may be recommended if other methods, such as pain medications or hormone therapy, are not alleviating symptoms like pain or infertility. Surgical procedures can be risky and lead to life-altering side effects, which is why they are not the first line of treatment used for endometriosis. It’s important to note, however, that there is no cure for endometriosis at this time. Even after surgery, endometriosis-related symptoms and pain may return, and fertility improvements made as a result of surgery may eventually decline again. It has been estimated that roughly 20% of women who have conservative endometriosis surgery experience symptoms again within two years, and around 40% or more may experience a return of symptoms within five years post-operation.4,5 Some experts suggest utilizing hormone therapy along with surgical interventions or after surgery to potentially decrease the rate of symptom recurrence.5 Some common surgical procedures for endometriosis include:

Laparoscopic surgery:

Also referred to as conservative surgery, laparoscopic surgery is a minimally invasive procedure that is used to diagnose endometriosis, as well as to remove endometriosis lesions or scar tissue.6

Laparotomy:

A laparotomy is a surgical procedure in which a large incision is made in the abdomen in order to view and address issues within the abdomen and pelvis. Laparotomies are infrequently used at this time. Instead, most surgeons and providers will opt for laparoscopic surgery, if possible.7

Hysterectomy:

A hysterectomy is a surgical procedure that involves removing the uterus. Some women with endometriosis receive a hysterectomy after all other efforts to control pain and endometriosis-related symptoms have failed to provide relief. However, it’s important to note that not even a complete hysterectomy can guarantee that endometriosis will never return.8

LUNA and PSN:

There are two currently utilized procedures aimed at relieving pain by destroying nerve fibers in the pelvis. These procedures are called laparoscopic uterine nerve ablation (LUNA) and presacral neurectomy (PSN). The major difference between these procedures is in which nerves they are targeting. In theory, by destroying certain nerve fibers in the pelvis, a woman’s pain perception may be altered, thus, reducing her overall pelvic pain levels.9

Fertility treatments

When a woman or couple is having difficulty becoming pregnant, it may be necessary to see a fertility specialist or reproductive endocrinologist. Reproductive endocrinologists are gynecologists who specialize in the treatment of infertility. If you visit your provider for infertility, they may run a variety or 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, your provider may recommend fertility medications designed to induce ovulation, lifestyle changes, or other non-invasive treatment options. However, in some cases, 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 woman become pregnant. They may be utilized when first-line treatment options have not led to pregnancy, or when a woman or couple wanting to become pregnant needs access to donor sperm or eggs. Examples of ART include in vitro fertilization, third party-assisted ART (utilizing a surrogate, gestational carrier, donor sperm, and/or donor eggs), and intrauterine insemination (also called artificial insemination).10,11

Home remedies

In some cases, traditional treatment options may not be managing endometriosis symptoms as well as an individual had hoped. In other cases, treatment may be helping to manage symptoms well, however, an individual may feel like lifestyle changes or other at-home adjustments may make them feel even better. In these cases, the use of home remedies may be pursued to relieve symptoms and to help feel like your best self. Below are some common lifestyle changes and home remedies a woman with endometriosis may consider trying and how they might impact her endometriosis. However, it’s important to note that these home remedies are not intended to be a replacement for traditional treatment options. These are meant to be utilized in addition to your prescribed endometriosis therapy. Before trying any home remedy or making large lifestyle changes, it is important to consult your healthcare provider. Common home remedies for endometriosis include:

  • Heat for relief from cramps
  • Exercise
  • Implementing diet changes

Complementary and alternative medicine

When a woman is undergoing treatment prescribed by her healthcare provider for her endometriosis, she is said to be under standard medical care. Treatment options that are used in combination with standard medical care and that have been approved by a healthcare provider are called complementary therapies or complementary medicine. In some cases, under a provider’s guidance and observation, an individual may choose to participate in an alternative treatment option instead of her standard medical care. As its definition implies, this is referred to as alternative medicine.12

It is important to note that no complementary or alternative medicinal practice should be attempted without the support and guidance of a trained healthcare professional. Several complementary and alternative medicinal practices that a woman with endometriosis may consider include:

Written by: Casey Hribar | Last reviewed: June 2018
View References