How Is Endometriosis Treated?
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Medically reviewed by Cordelia Nwankwo, MD
Endometriosis is a condition that causes abnormal tissue growth outside of the uterus, leading to a host of painful symptoms.
There is no cure for endometriosis, but treatments can help improve some symptoms.
The first lines of treatment are pain relievers and hormone therapy. However, other treatments such as surgery, complementary and alternative medicine, and lifestyle changes may also reduce pain and boost your quality of life.
Reaching out to mental health services and endometriosis support groups can also make it a bit easier to live with the condition.
Endometriosis is a condition that occurs when tissue similar to the lining of your uterus—called the endometrium—grows outside the uterus. When you are on your period, the tissue inside of the uterus becomes thick and then sheds. However, the tissue located outside of the uterus has no place to break down or shed. As a result of the excess tissue growth, people with endometriosis can develop lesions, which can cause pelvic pain, fatigue, and infertility.
There is no cure for endometriosis currently. If you receive a diagnosis for endometriosis, your healthcare provider—typically a gynecologist (a type of doctor who specializes in the female reproductive system)—may recommend several treatments to help you better manage symptoms.
Usually, hormone therapy and pain relievers are typically the first lines of treatment followed by surgery. If your condition is making it difficult for you to get pregnant, in vitro fertilization (IVF) may help you achieve pregnancy.
Related:The Stages of Endometriosis and What They Can Mean
Medications
The most common medications that your healthcare provider may prescribe to you are pain relievers or hormone therapy. Your exact treatment plan will depend on the symptoms you are experiencing.
If symptoms are mild, pain relievers like non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce pain. If you aren't trying to get pregnant, hormone-based therapies like birth control may also help ease symptoms.
Pain Relievers
To help reduce pain or cramping, your provider may recommend pain medication. There are two primary types of pain relievers: over-the-counter (OTC) and prescription medication.
If you're experiencing mild to moderate pain, OTC medications like non-steroidal anti-inflammatory drugs such as Advil or Motrin (ibuprofen) and Aleve (naproxen) can help reduce symptoms. However, if your pain doesn't subside with OTC medications, your provider can prescribe you a stronger medication.
Keep in mind: if you have heart disease, kidney disease, liver cirrhosis, or are more than 20 weeks pregnant, NSAIDs may not be safe to take. In such cases, talk to your healthcare provider about alternatives for pain relief.
Birth Control
Estrogen and progesterone are two types of reproductive hormones that play a role in your menstrual cycle and endometriosis symptoms. Most birth control pills contain estrogen and progesterone. While some people use birth control pills to prevent pregnancy, your provider can also recommend these medications to help you regulate your menstrual cycle, reduce heavy periods, and improve endometriosis symptoms by slowing down the growth of lesions.
Birth control pills don't come without side effects, however. If you start taking birth control, you may experience one or more of these side effects:
Spotting between periods
Stomach pain or bloating
Vaginal discharge
It's important to note that birth control pills will only help you manage symptoms if you are taking the medication regularly. Painful symptoms may return if you stop taking the medication.
Gonadotropin-Releasing (Antagonists and Agonists) Hormone
Gonadotropin-releasing hormone (GnRH) medications stop your body from releasing gonadotropins, follicle-stimulating hormones (FSH), and luteinizing hormone (LH)—all of which play a role in reducing your estrogen levels. Because high levels of estrogen can cause endometriosis lesions to grow and swell, GnRH medications work to slow or stop the growth of the lesions, which can help reduce pain and other symptoms.
GnRH medications are available as oral pills, nasal sprays, or injections. The most common nasal spray on the market is Synarel (nafarelin). Experts recommend to start using the nasal spray during your menstrual period and to stop using the spray after six months. Similarly, if you choose to receive injections, your healthcare provider will stop administering injections after six months of use.
However, a longer-term option for GnRH medication is an oral pill. Currently, the only oral pill that the Food and Drug Administration (FDA) has approved for endometriosis-related pain is Orilissa (elagolix). Healthcare providers advise taking Orilissa for no longer than six to 24 months, depending on your dose and the severity of your symptoms. Taking the medication for longer than this time period can cause early menopause and increase your risk of bone loss.
Additional side effects for any form of GnRH medication may also include:
Hot flashes
Fatigue
Trouble sleeping
Headache
Mood swings
Stiff joints and muscles
Progesterone and Progestin
Progesterone (a hormone) and progestin (an artificial form of progesterone) can help reduce the frequency of your periods and slow the growth of lesions. These medications are available as pills, injections, or through an intrauterine device (IUD).
The frequency of your medication will depend on the type of progesterone you choose. You can take medications daily, but your provider will only use an injection once every three months. If you prefer an IUD, your healthcare provider will insert the device into your uterus, which you can leave in your body for three to seven years.
These hormone treatments may also cause their own set of side effects, which can include:
Weight gain
Irregular or heavy menstrual bleeding
Keep in mind that while taking progesterone and progestin, even if your menstrual bleeding stops, there is still a small chance that you can become pregnant. Therefore, if you're sexually active but do not want to become pregnant, it's essential to take other measures to practice safe sex.
Related:What is Bowel Endometriosis?
Surgeries and Procedures
In the case where pain relievers and hormone treatment don't help to reduce endometriosis symptoms, your healthcare provider may suggest surgeries and procedures to help improve symptoms. There are two modes of surgeries that treat endometriosis: laparoscopy and laparotomy. A laparoscopy is considered the gold standard type of surgery for endometriosis, while a laparotomy is less often used today.
If you’re trying to get pregnant, both types of surgery may improve fertility by getting rid of lesions. However, your provider will refrain from recommending multiple surgeries, as more surgeries can increase the risk of harm to your reproductive organs.
Laparoscopy
A laparoscopy is the only way to diagnose endometriosis and is also one of the only surgeries that can treat symptoms. During a laparoscopy, a surgeon makes small incisions (cuts) in the lower region of your abdomen. Once the cut is made, they will insert a laparoscope (or, a device with a light and tiny camera on it) to check the inside of your pelvic region.
When inside the pelvic area, the surgeon can either remove lesions by taking them out with a cutting tool (e.g., scalpel or laser) or destroy the lesions by using heat, which is a process known as ablation. The surgeon may also remove any scar tissue surrounding your lesions that may be causing painful symptoms.
This procedure is a minimally-invasive surgery (meaning, it only requires a small number of cuts and stitches) that requires you to be asleep under general anesthesia. Usually, healthcare providers will recommend this surgery if you have moderate or severe pain.
Laparotomy
Unlike a laparoscopy, a laparotomy is a more invasive surgery that involves making larger incisions into your body to look for and remove lesions. This is one reason why a laparoscopy is the more common type of surgery today. Generally, your provider may recommend a laparatomy if all other forms of treatment have been unsuccessful.
During a laparotomy, a surgeon can sometimes perform a hysterectomy, which removes the uterus. Removing the uterus stops menstrual bleeding, which can help reduce painful symptoms. However, a hysterectomy also removes your chance of getting pregnant, if that is something you desire. Hysterectomy is not a cure for endometriosis, however, because endometriosis exists outside of the uterus.
Depending on your condition and the structure of your uterus, a surgeon may also remove the ovaries and fallopian tubes if lesions have caused severe damage to these areas of your reproductive system. It's essential to note that surgeons only remove all parts of your reproductive organ as a last-resort option.
In Vitro Fertilization (IVF)
If you’re trying to become pregnant but are having difficulty doing so because of endometriosis, your healthcare provider can recommend treatments for infertility. One of the most common fertility treatments is in vitro fertilization (IVF), which is a form of assisted reproductive technology (ART) that helps people become pregnant.
IVF is a lengthy, multi-step process, which includes:
Superovulation: First, you’ll take fertility drugs that increase the number of eggs that mature and ovulate. In comparison, only one egg matures and ovulates per menstrual cycle.
Egg retrieval: Your healthcare provider retrieves the mature eggs. Using a thin device inserted through the vagina, the healthcare provider will pull the mature eggs from the ovary.
Fertilization: Outside of your body in the fertility clinic's lab, an embryologist will fertilize the eggs in a petri dish using a sperm sample. In some cases, your provider may inject sperm into the eggs. Once the fertilized egg matures into an embryo (an organism in its earliest form), you can choose to freeze or transfer any embryos.
Embryo transfer: Lastly, using a thin device, the healthcare provider will transfer one or multiple embryos into your (or your surrogate's) uterus. Pregnancy begins if an embryo attaches inside the uterus. Typically, you can take an at-home pregnancy within 10 days of the embryo transfer.
Keep in mind that IVF and pregnancy do not treat painful symptoms or lesion growth. IVF is a treatment option solely for fertility.
Related:Health Risks Associated With Having a Baby at 40 and Older
Complementary and Alternative Medicine
Even with conventional treatments, many people with endometriosis still experience bouts of pain. Some evidence suggests that complementary and alternative medicine (CAM) may help alongside other therapies. There is not substantial research about CAM for endometriosis and more studies are needed to understand how well these treatments work. However, some people have tried the following treatments:
Acupuncture: This technique involves inserting tiny needles into your body’s trigger or pressure points. Some evidence suggests that acupuncture may treat painful symptoms. For example, a review published in 2017 in PLoS One found that acupuncture may alleviate pain and decrease cancer antigen 125 (CA-125) levels in the blood. People with endometriosis often have high CA-125 levels.
Massage: One review published in 2017 in the International Journal of Women’s Health found that different types of massages, like a pelvic massage, may relieve scar tissue that causes painful symptoms.
Herbs: Traditional Chinese medicine (TCM) recommends herbs to relieve painful symptoms. Per TCM, blood stasis (which occurs when blood flow stops or slows down) can lead to symptoms similar to endometriosis. According to one study published in 2015 in the International Journal of Clinical and Experimental Medicine, some evidence suggests that herbs may work as well as hormone therapy to reduce pain.
Physiotherapy: Exercises that work the pelvic region can decrease inflammation and relieve painful symptoms. Types of physiotherapy include kinesiotherapy (movement therapy), physical therapy, and hydrotherapy (water therapy).
Lifestyle
Endometriosis is a painful condition, that not only causes frustrating symptoms, but can disrupt your quality of life. Sometimes, symptoms can be so painful that you may find it difficult to go to school or work and complete daily tasks.
In addition to conventional treatments and CAM, some lifestyle changes can help, including:
Trying an anti-inflammatory diet: Some evidence suggests that cutting out certain foods, like gluten, high-fat dairy, and red meat can help decrease inflammation. While more research is needed to understand the connection between diet and endometriosis, you may find it beneficial to eat foods that are high in fiber and omega-3 and incorporate more fruits, vegetables, and whole grains into your diet.
Exercising regularly: Research has found that regularly exercising can help lower inflammation in your body. Exercising does not have to be rigorous for it to be beneficial. Try light activities that get your body moving without aggravating endometriosis-related pain. You might consider yoga, swimming, or daily walks as some options.
Getting quality sleep: Endometriosis symptoms can affect your quality of sleep. In fact, some evidence suggests that trouble sleeping is one of the most common complications of endometriosis. However, poor sleeping patterns can worsen painful symptoms and increase your risk of depression. If you have trouble sleeping, talk to your healthcare provider about what you can do to induce sleep. They may suggest certain medications or lifestyle changes to get your sleep back on track.
Living With and Managing Endometriosis
Endometriosis can significantly affect your quality of life—which is why it's important to get a diagnosis for the condition and get started on treatment as soon as you're able. As the condition progresses, you can experience increasing pain, larger lesions, and potentially infertility.
Specifically, endometriosis can affect your ability to carry out daily tasks, disrupt performance in school or at work, cause changes in your relationships, and hinder family planning. If left untreated, symptoms can also increase your risk of depression and anxiety.
Therefore, if you have endometriosis, prioritizing both your physical and mental health is vital. For example, cognitive-behavioral therapy (CBT) with a mental health professional can help you cope with any stress. Additionally, joining a support group may provide helpful resources and emotional support for people with endometriosis.
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