Endometriosis

Endometriosis Treatment

Treatments^[17] for endometriosis usually involve medication or surgery. In most cases, the management of endometriosis requires multiple approaches, generally utilizing^[18]:

• Surgical diagnosis and removal of as much of the disease as possible
• Pain management
• Hormone therapy, which helps suppress and delay the progression and return (recurrence) of the disease

Most healthcare providers recommend trying conservative treatments first. Surgery is usually reserved for cases in which initial treatments have failed. Ultimately, the particular approach taken to treating your condition will depend on the severity of your signs and symptoms, your personal preferences, and whether you plan on trying to become pregnant. If you do want to conceive, your healthcare provider may recommend that you receive fertility treatment under the supervision of a fertility specialist, such as in vitro fertilization or stimulating your ovaries to produce more eggs.

Hormone therapy for endometriosis

While hormone therapy isn’t a permanent solution for endometriosis (your signs and symptoms can return after treatment is stopped), it can help reduce or eliminate the pain caused by the disease. Hormonal treatments can also help slow the growth of endometrial tissue and prevent new implants of the tissue from forming. Hormonal birth control is usually the first line of treatment for women with endometriosis who are not trying to become pregnant^[19]. This may include:

• Extended-cycle birth control (which causes you to have only a few periods each year) or continuous-cycle birth control (which causes you to have no periods at all while on the medication): These types of birth control are available as either oral medications or injections. Both help reduce or eliminate pelvic pain and stop bleeding.
• An intrauterine device (IUD): This device is implanted into the uterus and protects against pregnancy for as long as 7 years. An IUD can help reduce both pain and bleeding, but may not do so for very long.

All forms of hormone therapies only work for as long as they are taken. These treatments are usually the most effective in women who do not have severe endometriosis pain or symptoms. If you are trying to become pregnant, your provider may prescribe a type of medication called a gonadotropin-releasing hormone (Gn-RH) agonist. Gn-RH agonists prevent the body from producing the hormones that cause ovulation, menstruation, and endometriosis, causing temporary menopause. Once you stop taking this medication, your menstrual cycle will return. You may also have a better chance of becoming pregnant.

Endometriosis medication

Your healthcare provider may recommend that you take an over-the-counter pain reliever, such as a nonsteroidal anti-inflammatory drug (NSAID), to help alleviate mild-to-moderate pelvic pain and menstrual cramps. These types of medications include naproxen sodium (generic Aleve) and ibuprofen (generic Advil, Motrin IB, others). In addition to taking pain relievers, your provider may recommend that you receive hormonal treatments (if you’re not trying to conceive). Some commonly used hormonal medications for endometriosis include:

• Hormonal contraceptives: These medications help control the hormones responsible for the buildup of endometrial tissue with each menstrual cycle. Using hormonal contraceptives, such as a birth control patch, pills, or vaginal ring, can sometimes help reduce or eliminate the pain associated with endometriosis. Many women also report experiencing lighter and shorter periods while using hormonal contraceptives.
• Progestin therapy: Progestin therapies, which include intrauterine devices (IUDs) with levonorgestrel (generic Mirena, Skyla), contraceptive injections (generic Depo-Provera), progestin pills (generic Camila), and contraceptive implants (generic Nexplanon), can help relieve the signs and symptoms of endometriosis by preventing menstrual periods and the growth of endometrial implants.
• Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists: These medications block the production of ovarian-stimulating hormones. This lowers the body’s estrogen levels and prevents menstruation from occurring, which, in turn, causes endometrial tissue to shrink.

Because these medications cause temporary artificial menopause, they can cause menopausal side effects, including hot flashes, bone loss, and vaginal dryness. These side effects are often addressed by taking a low dose of progestin or estrogen alongside Gn-RH agonists/antagonists.

• Aromatase inhibitors: This type of medication reduces the amount of estrogen in the body. Aromatase inhibitors are often prescribed to treat endometriosis alongside progestin or combination hormonal contraceptives.

Your provider may prescribe the following medications for endometriosis:

Endometriosis surgery

There are several surgeries^[20] used to diagnose and treat endometriosis, ranging from conservative to more invasive. Conservative surgical procedures (those that preserve the uterus and ovaries) are generally recommended for patients who are trying to become pregnant. Laparoscopy^[21] is the most common surgical procedure for endometriosis. It is used to both diagnose the disease and remove mild to moderate endometrial growths. In this procedure, a surgeon inserts a thin viewing instrument (called a laparoscope) and other surgical instruments used to remove endometrial tissue through a few small incisions in your abdomen. Laparoscopy is used to:

• Diagnose endometriosis by viewing the internal organs and checking for signs of the disease (as well as other problems that may be causing your signs and symptoms).
• Remove visible endometriosis growths (implants) and scar tissue that may be causing pain or contributing to infertility. If an ovarian endometriosis cyst (endometrioma) is found, it will also likely be removed.

A combination of hysterectomy (surgery to remove the uterus) and oophorectomy (surgery to remove the ovaries) was once considered the most effective treatment for endometriosis.

• When performed, hysterectomy for endometriosis is used to help alleviate signs and symptoms—such as heavy menstrual bleeding and painful menstruation—in women who do not want to become pregnant.
• Having the ovaries removed in an oophorectomy causes menopause. While the decrease in hormones produced by the ovaries can sometimes help improve endometriosis pain, some patients continue to experience symptoms even after surgery. Additionally, early menopause increases the risk of developing health complications, including cardiovascular diseases and certain metabolic disorders.

Unfortunately, endometriosis has been shown to recur in 5–15%^[22] of patients after undergoing these surgeries. Now, endometriosis experts focus instead on removing as much endometriosis tissue as possible through laparoscopy. Whether you need surgery—and, if you do, which type of procedure is best—will depend upon your healthcare provider’s or a specialist’s recommendation, as well as your personal preferences and treatment goals.