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Treatments for Endometriosis

Posted on August 21, 2018
Medically reviewed by
Peter J. Chen, M.D.
Article written by
Kelly Crumrin

While there is currently no cure for endometriosis, there are treatment options available to help ease the symptoms and limit progression of the disease. Specific treatment for endometriosis will be determined by your health care provider and based on the specifics of your condition, your age, overall health, medical history, and whether or not you plan to have children.

Generally, doctors recommend trying conservative treatment approaches — such as medication — first and reserving surgery as a last resort. Treatments for endometriosis fall into the categories of pain relief, hormonal treatment, and surgery.

Treatments for Pain

Pain is the most common symptom of endometriosis, and it can be severe. Pain medications for endometriosis range from over-the-counter pain relievers like Tylenol (Acetaminophen) to powerful opioids available only by prescription.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may work well for mild or moderate pain. Some NSAIDs, such as Aspirin, Advil (Ibuprofen), and Aleve (Naproxen), are available over the counter, while Celebrex (Celecoxib) and Voltaren (Diclofenac) require a prescription. NSAIDs are believed to work by inhibiting the production of chemicals that promote inflammation and blood clot formation in the body. Taken regularly at high doses, some NSAIDs can cause gastrointestinal problems and abnormal bleeding.

For more severe pain, some women require opioids such Codeine, Ultram (Tramadol), and Percocet (Oxycodone/Acetaminophen). Opioids are believed to work on the brain by altering the body’s ability to perceive pain. According to the National Institute on Drug Abuse, regular use of opioids — even as prescribed by a doctor — can lead to dependence. If misused, opioids can cause overdose and death.

Some women find that acupuncture treatments, heating pads, or transcutaneous electrical nerve stimulation (TENS) can provide endometriosis pain relief.

Hormonal Treatments for Endometriosis

Hormones regulate the reproductive system and the menstrual cycle. In women with endometriosis, hormone-based treatments seek to limit symptoms and slow the progress of the disease by controlling the level of hormones in the body. Hormonal treatments can offer the majority of women lighter and shorter menstrual periods, or even stop periods altogether. Most hormonal treatments are types of birth control. When treatment stops, the symptoms of endometriosis will return, as will the ability to become pregnant.

Combination Oral Contraceptives

Combination birth control pills contain two hormones: estrogen and progestin. Oral contraceptives make a woman’s period lighter, shorter, and more regular while keeping pain levels lower. There are a large number of branded and generic birth control pills on the market containing varying amounts of both hormones. Combination hormone therapy is also available as a skin patch or a vaginal ring.

Some women taking birth control pills experience mild side effects, such as weight gain, bloating, and bleeding between periods — especially for the first few weeks or months of taking them.

Progesterone and Progestin Therapy

Some birth control methods contain the single hormone progesterone or its synthetic version, progestin. Progestin-only treatments are administered as a pill, by injection such as Depo-Provera, or inserted as an intrauterine device (IUD), such as Mirena. Progestin-only therapies can shorten and lighten a woman's period or stop it altogether.

Oral forms include brands like Provera. Once a woman stops taking the progestin pill, symptoms can reappear.

Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

GnRH agonists and GnRH antagonists both work by preventing the production of estrogen, resulting in a temporary, reversible, menopause-like state. While taking drugs in these classes, women will not ovulate or menstruate, and they cannot get pregnant. Endometriosis symptoms are usually minimized, and the disease will not progress while taking the medication. Menstrual periods and fertility usually return after treatment with these drugs is stopped.

GnRH agonists, such as Lupron (Leuprorelin acetate), are administered as an intramuscular injection.

Orilissa (Elagolix) is a GnRH receptor antagonist. Orilissa is taken orally.

Common side effects of GnRH agonists and antagonists are symptoms typical of menopause, including hot flashes, tiredness, problems sleeping, headache, depression, joint and muscle stiffness, and vaginal dryness. Staying on these drugs for prolonged periods may raise the risk for heart complications and bone loss. Some doctors may recommend taking breaks between courses of GnRH agonists or antagonists. Add-back regimens with progesterone, such as daily oral Norethindrone, may be prescribed together with a GnRH agonist to help reduce side effects without sacrificing effectiveness in relieving pain.

Danocrine (Danazol) is another hormonal treatment that stops the release of hormones involved in the menstrual cycle. Danocrine is a male steroid hormone, or androgen, that creates a menopause-like effect similar to GnRH agonists and antagonists.

Many women experience side effects while taking Danocrine that include oily skin, acne, weight gain, muscle cramps, tiredness, smaller breasts, and sore breasts. Danocrine may cause masculinizing effects, such as a deepened voice or increased hair growth.

Surgery for Endometriosis

Laparoscopy is necessary to diagnose endometriosis, and many women undergo laparoscopic surgery to remove endometriosis implants. Some people may experience temporary relief of their symptoms following surgery.

Laparoscopy is a minimally invasive surgical method during which small incisions are made in the abdominal wall. The surgeon inserts a small camera and surgical tools into the pelvic cavity to examine and cut or burn away endometriosis implants and remove adhesions.

In more severe and extensive cases of endometriosis, laparotomy may be necessary. Also known as a traditional or open incision, laparotomy involves a longer abdominal incision to allow the surgeon full access to remove harder-to-reach endometriosis implants and adhesions while preserving healthy tissue.

Surgical ablation, or the removal of the network of nerves in the uterosacral region of the pelvis, has not been shown in several randomized trials to be effective in blocking pelvic pain caused by endometriosis.

In the most severe cases of endometriosis, a woman may opt for a hysterectomy to surgically remove the uterus and possibly the ovaries (oophorectomy). Hysterectomy may be performed via laparoscopy, with a traditional incision, or through the vagina. A hysterectomy may not stop symptoms of endometriosis since the body continues to produce estrogen.

After a hysterectomy, a woman will no longer be able to have children. If the ovaries are also removed, a woman will immediately enter menopause no matter what age she is. Hysterectomy, especially before the age of 35, has been shown to raise long-term risk for developing high blood pressure, obesity, and heart disease.

Can Diet Help Endometriosis?

Scientists have studied diet as it relates to the development of endometriosis. Research indicates that high-fat diets containing large amounts of red meat and animal fats increase the risk for developing endometriosis. The theory is that these foods may raise estrogen levels. The same studies show that women with diets high in fiber, fresh fruit, and vegetables were less likely to develop endometriosis than women with meat-based diets. There has not been a study on whether a similar diet can benefit women who already have endometriosis.

Alcohol and caffeine consumption can worsen symptoms for some women with endometriosis.

Read more details about endometriosis treatments.

Condition Guide

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Peter J. Chen, M.D. is a fellow of the American College of Obstetrics and Gynecology. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

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