Endometriosis treatments: What are the options?
Pain medications, hormone therapy and, in some cases, surgery can help manage pain and other endometriosis symptoms.
Endometriosis is a disorder in which tissue similar to the tissue that normally lines the inside of your uterus (the endometrium) grows outside the uterus. It's treated with medications or surgery. These treatments can help manage symptoms, though there's no cure for endometriosis.
Generally, doctors recommend conservative drug treatments first. Your doctor might also suggest conservative surgery (laparoscopy) to take a biopsy early on, as this is the only way for your doctor to know for sure whether you have endometriosis. But repeated or more-significant surgeries are usually saved as a last resort. This is because all surgery comes with risks, and endometriosis and pain sometimes persist even after 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.
Initial endometriosis treatments — pain medications and hormone therapies — aim to control pain and improve fertility by preventing progression of endometriosis tissue growth outside the uterus (endometrial implants).
An over-the-counter pain reliever, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) may ease painful menstrual cramps.
Your doctor may recommend hormone therapy in combination with pain relievers if you're not trying to get pregnant.
Supplemental hormones sometimes help reduce or eliminate endometriosis pain. These hormone medications can slow existing painful endometriosis tissue growth and prevent new endometriosis implants from forming.
Hormone therapy isn't a permanent fix for endometriosis. You could experience a return of symptoms after stopping treatment.
Endometriosis hormone therapies include:
- Hormonal contraceptives. Birth control pills, patches and vaginal rings help control the hormones responsible for the monthly buildup of both normal endometrial tissue inside the uterus and abnormal endometrial tissue implants outside the uterus. Many 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 pain in some cases.
- 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, Skyla), contraceptive implant (Nexplanon) or contraceptive injection (Depo-Provera), or progestin pill (Camila) can halt menstrual periods and the growth of endometrial tissue implants, which may relieve endometriosis symptoms.
- Aromatase inhibitors. Aromatase inhibitors are a class of medicines that reduce the amount of estrogen in your body. Your doctor may recommend an aromatase inhibitor along with a progestin or combination hormonal contraceptive to treat endometriosis.
If you have endometriosis and are trying to become pregnant, surgery to remove as much endometriosis as possible while leaving your uterus and ovaries intact (conservative surgery) may increase your chances of success. Conservative surgery might also help if you have severe pain from endometriosis. However, endometriosis and pain can return.
This procedure may be done using small instruments inserted through incisions in your abdomen (laparoscopically) or through traditional abdominal surgery in more extensive cases. After surgery, your doctor may recommend taking hormone medication to help improve pain.
Endometriosis can lead to trouble getting pregnant. If you're having trouble, your doctor may suggest fertility treatment supervised by a fertility specialist. Fertility treatment ranges from stimulating your ovaries to make more eggs to in vitro fertilization. Which treatment is right for you depends on your personal situation.
Hysterectomy with removal of the ovaries
Surgery to remove the uterus (hysterectomy) and ovaries (oophorectomy) was once considered the most effective treatment for endometriosis. But endometriosis experts are moving away from this approach, instead focusing on the careful and thorough removal of all endometriosis tissue.
Having your ovaries removed results in menopause. The lack of hormones produced by the ovaries may improve endometriosis pain for some, but for others, endometriosis that remains after surgery continues to cause symptoms. Early menopause also carries a risk of heart and blood vessel (cardiovascular) diseases, certain metabolic conditions and early death.
Removal of the uterus (hysterectomy) can sometimes be used to treat signs and symptoms associated with endometriosis, such as heavy menstrual bleeding and painful menses due to uterine cramping, in those who don't want to become pregnant. Even when the ovaries are left in place, a hysterectomy may still have a long-term effect on your health, especially if you have the surgery before age 35.
Finding a doctor with whom you feel comfortable is crucial in managing and treating endometriosis. You may want to get a second opinion before starting any treatment to be sure you know all of your options and the possible outcomes.
Jan. 30, 2020
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