How Endometriosis Is Treated

Endometriosis is a condition in which tissue that is similar to the type that lines the uterus starts to grow in other parts of the body, only outside the uterus. During your menstrual cycle, this tissue that grows outside the uterus acts like the ones inside the uterus—it thickens and then breaks down.

However, there is nowhere for the broken down tissue to pass out of the body, so it stays in place and causes the surrounding organs and tissue to become irritated. It also causes lesions and the eventual formation of scar tissue.

Some of the symptoms of endometriosis include painful periods (dysmenorrhea), heavy periods, pelvic pain, pain during sex (dyspareunia), pain during urination or bowel movement, infertility, fatigue, diarrhea, and nausea.

Endometriosis is a chronic and painful condition, and treatments for it are geared towards alleviating the pain that accompanies it. Since endometriosis also sometimes negatively affects fertility, some of the treatments are also targetted at improving fertility.

Prescriptions

If you’ve been diagnosed with endometriosis, your healthcare provider may prescribe one or a combination of the following medication.

Pain Medication

In cases where the pain from the endometriosis is moderate to severe, the practitioner may prescribe strong pain medication like opioids to help deal with it. Only available through prescription, opioids can be addictive and they should therefore never be misused.

In July 2018, the FDA approved Orilissa (elagolix) for treating endometriosis pain. Your healthcare provider may prescribe it to treat the pain experienced during periods, between periods, and during sex, as is characteristic of endometriosis.

In August 2022, the FDA approved Myfembree (relugolix, estradiol, and norethindrone acetate) for treating moderate to severe pain associated with endometriosis. The use of both medications to treat endometriosis pain is limited to 24 months due to the risk of bone loss.

Hormone Treatment

The body’s hormones directly affect endometriosis. Estrogen, in particular, worsens endometriosis symptoms, so hormone therapies are tailored to controlling estrogen production, and consequently, reducing pain. Hormonal treatments may also help to slow down the growth of endometriosis patches/implants (the tissue that grows outside the uterus).

Birth Control Pills

These help to keep the hormones responsible for the growth and build up of endometriosis patches under control. This results in lighter, shorter, and more regular menstrual periods with less cramping and pain. Also, depending on how they are prescribed by your healthcare provider, the pills may make you stop experiencing periods altogether.

These pills contain synthetic estrogen and progesterone, and their effects only last while they are being used. Once the pills are discontinued, the painful and heavy periods may return.

Progestin/Progesterone

Progesterone (natural) and progestin (a synthetic version) therapy reduces or in most cases stops the occurrence of periods, helps to reduce the symptoms of endometriosis, and slows the growth of endometrial implants. Progestin can be taken as a pill, injection, or through an intrauterine device (IUD). If taken as a pill, the effects of progestin stop once the pill is discontinued. If taken through an IUD or via injections, it may take months or longer before the effects "wear off" and the period and symptoms return.

There are different types of progestins and the ones that may work for one person may not work for another. Therefore, your healthcare provider may suggest a sort of trial-and-error approach to your treatment. Progestin therapy has many side effects associated with it, some of which include bloating, depression, headaches, irregular bleeding, moodiness, lethargy, dizziness, nausea, acne, and weight gain.

Gonadotropin-Releasing Hormone (GnRH) Agonists

These drugs improve endometriosis symptoms by suppressing the production of the gonadotropins, luteinizing hormone (LH), and follicle stimulating hormones (FSH). The reduction in their production leads to a significant decrease in the production of estrogen, stopping the growth of endometriosis implants and causing the existing ones to eventually degenerate. 

GnRH agonists can be taken as a daily nasal spray, a daily injection, a monthly injection, or quarterly injection. Your healthcare provider will likely recommend that you do not take this drug long term at a stretch. Instead, its use should be limited to six months, after which a break should be had.

It can be said that GnRH agonists induce medical menopause temporarily. Consequently, many of the symptoms of menopause like hot flashes, vaginal dryness, loss of libido, mood swings, changes in breast size, bone thinning, and insomnia may be present as side effects when you are using this drug. However, once you stop using the drugs, your body will stop acting menopausal and your periods will return.

Danazol

This drug is a synthetic form of androgens (androgens are hormones that give men their characteristic "male" traits.) Danazol treats endometriosis by stopping the ovaries from releasing the hormones responsible for menstrual cycles. This means that while on this drug, you will stop having your period. Danazol is very effective at reducing endometriosis pain but is not usually the first line of treatment because its side effects can be severe—more so than other hormone therapies.

It can cause acne, deepening of the voice, weight gain, sore breasts, hot flashes, fatigue, increase in body hair, mood swings, and headaches. Long-term use of danazol is also associated with impaired liver function.

Danazol does not act as a contraceptive, and can also harm fetuses. It is therefore important to prevent a pregnancy when you’re using this drug. If your healthcare provider wants to prescribe this drug, you should also inform him/her if there’s even a slight possibility that you may be pregnant. However, in practice, most medical professionals will recommend that you start using danazol on the first day of your period as that shows—with at least reasonable certainty—that you aren’t pregnant.

None of the hormonal treatments should be used if you’re trying to get pregnant. Instead, you should explore other options with your healthcare provider.

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Surgeries and Specialist-Driven Procedures

Surgical procedures for endometriosis are usually considered when the pain is severe.

Laparoscopy

The only way to confirm a diagnosis of endometriosis, a laparoscopy is also used to treat it. It involves making small incisions in the abdomen and inserting a laparoscope (a small, thin medical viewing instrument) to see the uterus and other surrounding organs.

When it's used to treat endometriosis, the laparoscope is fitted with surgical instruments that the healthcare provider will use to remove the endometriosis implants and lesions, while taking care to avoid damaging healthy tissue around it. The practitioner may also decide to remove any scar tissue that has formed to further the goal of pain relief. 

In some cases, hormone therapy will still be prescribed for use even after this surgery has been performed.

Pain relief from having a laparoscopy is usually temporary, and the pain may return after a while. According to the American College of Obstetrics, about 40 to 80 percent of women experience pain again within two years of their surgical procedure.

Laparotomy

This is a surgery that is only rarely used now as most women with endometriosis can be treated with a laparoscopy instead. It involves making a large incision into the abdomen in order to remove the endometriosis implants. In cases of severe pain from the endometriosis, the practitioner may decide to perform a hysterectomy (removal of the uterus) through the laparotomy. If the healthcare provider decides to remove the cervix alongside the uterus, it is called a total hysterectomy. 

In rare cases, the healthcare provider may also recommend that the fallopian tubes and ovaries be removed too—a process called a salpingo-oophorectomy.

Over-the-Counter (OTC) Therapies

If the pain from your endometriosis is mild, you may use over the counter pain medication, like nonsteroidal anti-inflammatory drugs (NSAIDS) successfully. If possible, you should ask your healthcare provider for recommendations on which ones may work best for you. To further alleviate your pain symptoms, your practitioner may also suggest that you combine the use of these OTC pain medications with hormone treatments.

Home Remedies and Lifestyle

In addition to prescription medications, surgeries, and over-the-counter therapies, there are several lifestyle changes you can make from home that may improve the symptoms of your endometriosis.

Dietary Changes

Making some simple changes to your diet may help with the pain. There is some evidence that cutting back on high-fat dairy, red meat may help reduce the severity of endometriosis. Vegetables and flaxseed are foods that may reduce your pain in symptoms. Some research also shows that foods like sardines and salmons that contain omega 3 fatty acids may also be able to help with the pain as well as slow down the growth of endometriosis implants. Omega 3s are available in supplement form.

Exercise

Exercise releases endorphins (feel-good hormones) in the body which can help reduce pain. There is no general consensus that exercise helps endometriosis pain in particular, as systematic reviews conclude that the data available is inconclusive on the benefits of exercise for endometriosis. However, exercise has so many other health benefits that it may be a good idea to try it as a pain-relieving tool for endometriosis.

Sitz baths

When done regularly, sitz baths may help to relieve endometriosis pain. It involves sitting in a basin or partially filled bathtub of warm water for some minutes.

Complementary Alternative Medicine (CAM)

Although some alternative therapies lack strong scientific backing, there is some reason to believe that they may provide relief from the pain.

Progesterone Cream

Progesterone slows the growth of endometriosis implants and reduces the accompanying pain, as evidence in the use of progestin pills and injections as standard endometriosis treatment. It is thought that progesterone creams may have a similar (albeit, milder) effect. The cream is usually applied to the wrist, arms, chest, and thighs as directed by an expert.

It is important to note, however, that there are no studies supporting the efficacy of progesterone creams for endometriosis. Because of this, you should inform your healthcare provider before you begin to use one.

Treatment for Endometriosis-Related Infertility

One of the common complications of endometriosis is reduced fertility or infertility. If you are having problems conceiving as a result of your endometriosis, your healthcare provider may recommend the following options to you.

Laparoscopy

This surgery is performed the same as when it is used to relieve pain as a symptom of endometriosis. The removal of the endometriosis implants has been shown to improve the chances of pregnancy in cases of mild endometriosis.

In-Vitro Fertilization (IVF)

If a laparoscopy does not help you achieve pregnancy, IVF is the next option. IVF is a type of assistive reproductive technology that involves taking many eggs and combining them with sperm cells in a petri dish. In successful cases, some eggs will become fertilized and become embryos after which a couple of the healthy embryos will be transferred to your uterus. IVF can be a very expensive procedure and may not be covered by insurance.

A Word From Verywell

Endometriosis can be a very painful condition to deal with. It is important that you explore your options extensively with your healthcare provider before settling on a course of treatment. It may also be helpful to keep in mind that you may have to undergo some trial and error to find the right treatment that’ll help your pain symptoms. Just because a particular treatment may not be effective for you doesn't mean the next one won’t be.

If you are experiencing infertility due to your endometriosis, if you can, try seeing a fertility doctor to assist and put you on the right track during your journey to conceive. Finally, you should consider joining a support group for women with endometriosis. This may help you cope and feel understood throughout your journey with your condition.