Treatment

Treatment for endometriosis is usually with medications or surgery. The approach you and your doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant.

Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.

Pain medications

Your doctor may recommend that you take an over-the-counter pain reliever, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others), to help ease painful menstrual cramps.

If you find that taking the maximum dose of these medications doesn't provide full relief, you may need to try another approach to manage your signs and symptoms.

Hormone therapy

Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue.

Hormone therapy isn't a permanent fix for endometriosis. You could experience a return of your symptoms after stopping treatment.

Therapies used to treat endometriosis include:

  • Hormonal contraceptives. Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Most women have lighter and shorter menstrual flow when they're using a hormonal contraceptive. Using hormonal contraceptives — especially continuous cycle regimens — may reduce or eliminate the pain of mild to moderate endometriosis.
  • Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these drugs create an artificial menopause, taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease menopausal side effects, such as hot flashes, vaginal dryness and bone loss. Your periods and the ability to get pregnant return when you stop taking the medication.
  • Progestin therapy. A progestin-only contraceptive, such as an intrauterine device (Mirena), contraceptive implant or contraceptive injection (Depo-Provera), can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.
  • Danazol. This drug suppresses the growth of the endometrium by blocking the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis. However, danazol may not be the first choice because it can cause serious side effects and can be harmful to the baby if you become pregnant while taking this medication.

Conservative surgery

If you have endometriosis and are trying to become pregnant, surgery to remove as much endometriosis as possible while preserving your uterus and ovaries (conservative surgery) may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery — however, endometriosis and pain may return.

Your doctor may do this procedure laparoscopically or through traditional abdominal surgery in more extensive cases. In laparoscopic surgery, your surgeon inserts a slender viewing instrument (laparoscope) through a small incision near your navel and inserts instruments to remove endometrial tissue through another small incision.

Assisted reproductive technologies

Assisted reproductive technologies, such as in vitro fertilization, to help you become pregnant are sometimes preferable to conservative surgery. Doctors often suggest one of these approaches if conservative surgery doesn't work.

Hysterectomy

In severe cases of endometriosis, surgery to remove the uterus and cervix (total hysterectomy) as well as both ovaries may be the best treatment. A hysterectomy alone is not effective — the estrogen your ovaries produce can stimulate any remaining endometriosis and cause pain to persist. A hysterectomy is typically considered a last resort, especially for women still in their reproductive years. You can't get pregnant after a hysterectomy.

Finding a doctor with whom you feel comfortable is crucial in managing and treating endometriosis. You may also want to get a second opinion before starting any treatment to be sure you know all of your options and the possible outcomes.

Aug. 20, 2016
References
  1. Endometriosis. The National Women's Health Information Center. http://www.womenshealth.gov/publications/our-publications/fact-sheet/endometriosis.html. Accessed July 26, 2016.
  2. Schenken RS. Endometriosis: Pathogenesis, clinical features, and diagnosis. http://www.uptodate.com/home. Accessed July 26, 2016.
  3. Frequently asked questions. Gynecological problems FAQ013. Endometriosis. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq013.pdf?dmc=1&ts=20130305T1348596508. Accessed July 26, 2016.
  4. AskMayoExpert. Endometriosis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
  5. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 114: Management of endometriosis. Obstetrics & Gynecology. 2010;116:223.
  6. What is assisted reproductive technology? Centers for Disease Control and Prevention. http://www.cdc.gov/art/whatis.html. Accessed July 26, 2016.
  7. Schenken RS. Endometriosis: Treatment of pelvic pain. http://www.uptodate.com/home. Accessed July 26, 2016.
  8. Lebovic DI. Endometriosis: Surgical management of pelvic pain. http://www.uptodate.com/home. Accessed July 26, 2016.
  9. Pearce CL, et al. Association between endometriosis and risk of histological subtypes of ovarian cancer: A pooled analysis of case-control studies. The Lancet Oncology. 2012;13:385.
  10. Jameson JL, et al. Endometriosis. In: Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, Pa.: Elsevier Saunders; 2016. https://www.clinicalkey.com. Accessed July 26, 2016.
  11. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: A committee opinion. Fertility and Sterility. 2012;98:591.
  12. Schrager S, et al. Evaluation and treatment of endometriosis. American Family Physician. 2013;87:107.
  13. Ferri FF. Endometriosis. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed July 26, 2016.
  14. Burney RO, et al. Pathogenesis and pathophysiology of endometriosis. Fertility and Sterility. 2012;98:511.
  15. Butler Tobah Y (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 3, 2016.