Types of Endometriosis Medications
Endo edications can suppress ovulation, reduce inflammation, and control spasms
Medically reviewed by Chioma Ndubisi, MD
Endometriosis occurs when tissue similar to that which normally lines the uterus grows outside the uterus. There is no cure for endometriosis. However, symptoms can be managed with medication.
This article covers which symptoms endometriosis medications target, the types of endometriosis medications, alternative endometriosis medications, the benefits and risks of these medications, and what to do if endometriosis medications don't work for you.
What Is the Goal of Endometriosis Medication?
The goal of endometriosis medication is to stop or minimize symptoms so they don't interfere with daily life. Symptoms of endometriosis can include:
Severe pain during periods or also during other times
Pain during and after sex
Pain when releasing stools or urinating
General lower back or stomach pain
Blood in urine or stools
Constipation or diarrhea
Difficulty getting pregnant
Lesions inside the pelvis, bladder, ovaries, rectum, or ovaries
Endometriosis Medication Options
Endometriosis treatment can include pain medication and hormone therapy. Antibiotics have also shown some promise in recent studies.
Pain Medication
Pain medications for endometriosis are more likely to be effective if other symptoms (like bleeding) are mild. These include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter (OTC) drugs like Advil or Motrin (ibuprofen) or prescription NSAIDs that reduce inflammation
Tylenol (acetaminophen)
Prescription pain relievers
Codeine and other opioids
O4LIWWQ (elagolix)
Research indicates that endometriosis patients could be at risk for addiction if pain is managed with opioids. Your body can build a tolerance to the drugs, which can lead to taking higher doses over time. This can increase your risk of addiction. It's advised to take opioids sparingly when managing pain.
Hormone therapy can help with symptoms of endometriosis while reducing inflammation and endo lesions. Options for hormone therapy include:
Oral contraceptives (birth control pills): It's advised that people at risk of heart disease take progestin-only birth control.
Gonadotropin-releasing hormone (GnRH) medications: These drugs slow ovulation (when the ovaries release eggs) and even cause a menopause-like state.
Progesterone and progestin: These drugs reduce or stop periods while preventing pregnancy.
Danazol: This androgenic hormone limits or eliminates periods.
Oral Contraceptives (Birth Control Pills)
For endometriosis, birth control pills can do the following:
Decrease period bleeding and shorten periods while preventing pregnancy
Cause endo symptoms, like pain and excess bleeding, to resolve with long-term use, although they may return if birth control is stopped
Cause possible side effects like bloating, weight gain, or bleeding between periods
Birth control usually contains the hormones estrogen and progestin. If you're at risk for heart disease or blood clots, you may be precribed the progestin-only pill (the minipill).
Gonadotropin-Releasing Hormone (GnRH)
GnRH can be taken as a nasal spray or as an injection every month or every three months. GnRH pills are normally taken for six months at a time, with breaks of several months in between.
GnRH medications can:
Prevent the production of hormones that cause ovulation and periods
Limit or prevent endometrial growth
Increase the risk of bone loss or heart problems with long-term use
Cause endometriosis symptoms or regular periods (and fertility) to return if discontinued
Cause side effects such as hot flashes, exhaustion, sleep issues, headaches, depression, muscle or joint stiffness, or vaginal dryness
Progesterone and Progestin
Progesterone and progestin can be taken orally, as an injection, or through an intrauterine device (IUD). Progestin injections might not stop all period bleeding, and irregular periods can occur.
Progesterone and progestin can:
Reduce or stop periods while preventing pregnancy
Reduce endo lesions when using some IUDs with progestin
Cause a delayed return to normal periods after stopping progesterone
Cause side effects such as weight gain and depression
While pregnancy risk is lowered while taking progesterone, it's advised to continue taking precautions if someone does not want to get pregnant.
Danazol
Danazol usually is taken as a capsule twice daily.
Danazol can:
Block hormones that cause menstruation
Limit periods or stop them completely
Cause side effects, including acne, weight gain, muscle cramps, tiredness, smaller and sore breasts, headaches, dizziness, hot flashes, or a deepening of the voice.
Harm fetuses, so it's advised to prevent pregnancy using condoms or a diaphragm
Antibiotics
A 2019 study found a combination of antibiotics reduced the size of endo lesions and lessened inflammation in mice with endometriosis. When the antibiotic metronidazole was used by itself, the endo lesions became much smaller.
The study also revealed that endometriosis could be reintroduced into treated mice by being fed bacteria from mice with the condition. This raised the possibility of a connection between gut bacteria and endometriosis.
Medications for Secondary Endo Conditions
Secondary endo conditions can also be managed with medication. These include the following:
Pain Medications
The following could help with endometriosis-related pelvic pain:
Transcutaneous electrical nerve stimulator (TENS) machines: Small machines with electric signals that either block pain signals or produce pain-fighters in the body
Anticonvulsant medication: Anti-seizure medications
Tricyclic antidepressants: Could block pain signals from reaching the brain
Muscle injections: Pain relief injections that target muscles
Medications for Mood
More than two-thirds of women with endometriosis also experience some form of psychological stress, including anxiety and/or depression. Reasons for endometriosis-related stress include continuous pain, difficulty getting a diagnosis because of misconceptions about menstruation pain, stigma about fertility issues, losing workdays, cost of treatment, and social isolation.
To treat depression related to endometriosis, a healthcare professional might recommend:
Antianxiety medications or beta-blockers
Support groups, creating support systems in daily life, and attending talk therapy
Diuretics and Antihistamines
Diuretics (water pills): Diuretics are drugs and foods that reduce water in the body. They could help with bloating, or "endo belly." Speak to a healthcare professional before taking diuretics if you take any other medications to prevent harmful drug interactions.
Antihistamines: Dramamine (dimenhydrinate) and some other antihistamines could help with nausea.
Alternative Endometriosis Medications
Research indicates people could manage endometriosis and premenstrual (PMS) symptoms with alternative medications. Before trying alternative therapies, speak to a healthcare professional or pharmacist about potential drug interactions.
OTC Alternatives
Medications include:
Tums EX: Calcium carbonate could help with physical and mood symptoms of PMS.
Probiotics: These supplements can be beneficial for patients with advanced endometriosis.
Vitamin Supplements
Vitamin supplements that can help manage symptoms include:
Quercetin and resveratrol
Vitamins C and E
Herbal Supplements
Some herbal supplements that have been found to be possibly helpful to endometriosis patients include:
Herbs
Several studies have indicated traditional Chinese medicine herbs may help with endometriosis symptoms. Some combinations that have shown promise include:
Peony and licorice
Cinnamon twig and poria
Ginseng and longan
Fennel Seed and corydalis
Costs could keep someone from sticking to endometriosis treatment long-term. When choosing a medication, it's advised to consider:
Short-term and long-term costs of a particular treatment
Side effects and how they can be managed
How easily the medication is tolerated by your system
Safety
Pregnancy concerns
Ways to manage costs might include:
Community clinics funded by the federal government, which can be searched via a clinic finder from the Department of Health and Human Services
Patient assistance programs: Cost-saving programs from manufacturers of medications, which can be found on the manufacturers' websites
Pharmacy discount cards from a healthcare provider or pharmacist
Organizations like NeedyMeds or Healthwell Foundation
Does Endometriosis Go Away With Medication?
Endometriosis has no cure. The goal of treatment is to manage symptoms so they don't interfere with daily life.
Weighing the Benefits vs. Risks of Endometriosis Medication
The benefits of endometriosis medication include:
Reduced pain
Less inflammation, which can also limit growth of endo lesions
Relief from heavy bleeding
Improving mood
Better work/school quality and attendance
Feeling socially connected
Risks of endometriosis medications include:
Mood changes
Weight gain
Headaches
Exhaustion
Bone loss
Heart problems
Lower likelihood of pregnancy while on medication
Vaginal dryness
Some things to consider when weighing benefits and risks of endometriosis might include:
How effective a medication is for you
How tolerable or manageable any side effects are for you
Long-term safety
Costs
Availability
Work schedule and lifestyle
Social needs
Personal goals, such as weight maintenance, having children, or improving mood
When seeking endometriosis treatment, it's advised to see a healthcare provider who specializes in women's health care (gynecology). In some states, pharmacists can prescribe birth control and some pain medications (usually at low or limited doses and/or in case of emergency). A pharmacist might also be able to work with your healthcare provider on a care plan that could give the pharmacist prescribing authority, depending on your medication and location. Speak to your pharmacist for more information.
Endometriosis Medication Isn’t Working: Next Steps
If endometriosis medication doesn't seem to work, it might be time to consider surgical options.
Laparoscopy/Laparotomy
A laparoscopy is a minimally invasive procedure in which a surgeon diagnoses a condition by making a small incision near the belly button and inserting a thin tube with a camera attached. The surgeon can then remove endometriosis patches (which can require more small cuts).
Endo lesions can reappear within five years after a laparotomy in about 20% of patients, and 1% of patients might experience complications, including organ infection or heavy bleeding. Fertility can improve after a laparotomy.
Hysterectomy
A hysterectomy is a complete removal of the uterus. Hysterectomies are usually a last-resort option used when other treatments have failed to improve quality of life and in patients who have decided not to have children.
Endometriosis symptoms can return if a hysterectomy doesn't include removing the ovaries, where hormones are produced. However, removing ovaries can mean starting menopause early. Treating menopause symptoms can require taking estrogen, which can cause endometriosis symptoms to return. Most women who undergo a hysterectomy choose to keep their ovaries. About 5% of those who undergo a hysterectomy can experience complications like organ damage or infection.
Summary
Endometriosis has no cure, but its symptoms can be managed with medication. These symptoms include heavy bleeding, intense or long-term pain, bloating, nausea, depression, and anxiety.
Surgery to remove lesions or the uterus itself might be preferred if medications don't heal endometriosis symptoms. Surgery does not guarantee endometriosis symptoms will disappear.