Endometriosis treatments: What are the options?

Pain medications, hormone therapy and, in some cases, surgery can help manage pain and other endometriosis symptoms.

Endometriosis — a disorder in which tissue that normally lines the inside of your uterus (the endometrium) grows outside your uterus — is 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 treatment

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).

Pain medications

An over-the-counter pain reliever, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) may ease painful menstrual cramps.

If the maximum dose of these medications doesn't provide full relief, you may need other treatments.

Hormone therapy

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, but it can be used for long periods of time. Long-term therapy is needed as endometriosis can continue to cause symptoms until menopause. 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. 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 tissue implants, which may relieve endometriosis 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 a 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 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 advanced cases.

Assisted reproductive technologies

If you're trying to get pregnant, assisted reproductive technologies such as in vitro fertilization, which may help you become pregnant, are sometimes preferred over conservative surgery. Doctors may also suggest such an approach 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 endometrial tissue implants 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.

Jan. 30, 2018 See more In-depth