Types of Endometriosis Medications

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.

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:

• Antidepressants
• 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
• N-acetylcysteine
• Vitamins C and E
• Omega-3 and omega-6: Anti-inflammatory

Herbal Supplements

Some herbal supplements that have been found to be possibly helpful to endometriosis patients include:

• Turmeric (curcumin)
• Black cohosh
• Chasteberry (vitex)
• Evening primrose oil
• Licorice root

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
  

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

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.