Endometriosis Treatment
Dr. Kate Dudek • February 18, 2019 • 5 min read
There is no cure for endometriosis. The treatment provided aims to reduce the severity of the symptoms and improve quality of life. The exact treatment offered will depend on the symptoms, patient age, fertility and priority of starting a family.
Broadly speaking, there are two types of treatment; medication and surgery.
Medication
If their endometriosis is causing pain, patients will be offered medication to ease this. Drugs such as non-steroidal anti-inflammatories (NSAIDs) and paracetamol may help to ease painful menstrual cramps.
Some patients will be prescribed hormonal therapy to help alleviate their symptoms. The combined oral contraceptive pill and progestin therapies, such as the mirena coil, are used to reduce the buildup of endometrial tissue every month. They do this either by preventing monthly menstruation completely, or by making the menstrual flow a lot lighter and shorter. With fewer endometrial deposits, inflammation will be reduced and patients will experience less pain. Gonadotrophin-releasing hormone (GnRH) analogues and testosterone derivatives both block oestrogen production, essentially putting the body into a state of artificial menopause.
The problem with hormonal treatment is that it will not help to improve fertility, quite the reverse in fact. Most hormonal options cause the body to enter into a state of artificial pregnancy or menopause, thus preventing fertilisation and implantation. Therefore, this treatment is not suitable for those patients who are seeking help to conceive.
Surgery
The first line of treatment for women experiencing endometriosis-associated infertility is to undergo a laparoscopy, a surgical process where a camera is inserted through the abdomen in order to examine the underlying organs. This is classed as conservative surgery. Used in the first instance for diagnosis, surgeons will attempt to remove accessible endometrial deposits at the same time. This treatment is reasonably effective for patients with mild-moderate endometriosis. The drawback is that there is a high recurrence rate, so symptomatic relief may only be temporary.
It is believed that between 5 and 20% of women with endometriosis will get recurrence of symptoms each year, probably due to further endometrial deposits forming. A year after surgery, 45% of women are likely to report that they are experiencing pain again.
More radical surgery involves removal of the uterus (hysterectomy) and/or ovaries (oophorectomy). Removing the ovaries causes an instant and irreversible menopause and is thus only suitable for women who are not planning on having children.
Optimal treatment strategies for endometriosis will generally incorporate a multidisciplinary approach, with a view to treating both the physical and psychological effects of the condition.
Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and menopause.
Get in touch if you have any questions about this article or any aspect of women’s health. We’re here for you.
Sources:
- Bulletti, C, et al. “Endometriosis and Infertility.” Journal of Assisted Reproduction and Genetics, vol. 27, no. 8, 25 June 2010, pp. 441–447., doi: 10.1007/s10815-010-9436-1.
- D’Hooghe, T, and L Hummelshoj . “Multi-Disciplinary Centres/Networks of Excellence for Endometriosis Management and Research: a Proposal.” Human Reproduction, vol. 21, no. 11, Nov. 2006, pp. 2743–2748., doi:10.1093/humrep/del123.
- Endometriosis Treatment. Endometriosis UK, www.endometriosis-uk.org/endometriosis-treatment.
- Endometriosis. Mayo Clinic, 24 July 2018, https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661.
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Polycystic Ovary Syndrome .” NHS Choices, NHS, [www.nhs.uk/conditions/polycystic-ovary-syndrome-](http://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/)[pcos](https://nabtahealth.com/glossary/pcos/)/treatment/. * Yarandi, Razieh Bidhendi, et al. “Metformin Therapy before Conception versus throughout the Pregnancy and Risk of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus in Women with Polycystic Ovary Syndrome: a Systemic Review, Meta-Analysis and Meta-Regression.” Diabetology & Metabolic Syndrome, vol. 11, no. 1, 23 July 2019, doi:10.1186/s13098-019-0453-7. * Zhou, Joseph, et al. “Metformin: An Old Drug with New Applications.” International Journal of Molecular Sciences, vol. 19, no. 10, 21 Sept. 2018, p. 2863., doi:10.3390/ijms19102863.
How Often Should I see a Doctor for Endometriosis?
There is no definitive rule with regards to how often you should see a doctor if you have [endometriosis](https://nabtahealth.com/glossary/endometriosis/). The main thing is to find a _sympathetic doctor_ who will take the time to listen to any concerns you might have. [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) can be [difficult to diagnose](https://nabtahealth.com/how-is-endometriosis-diagnosed/) and often the [symptoms](../the-symptoms-of-endometriosis) will closely resemble those of other conditions, such as [irritable bowel syndrome](https://nabtahealth.com/glossary/irritable-bowel-syndrome/) ([IBS](https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome)). For this reason you may initially be referred to a [gastroenterologist](https://nabtahealth.com/glossary/gastroenterologist/) rather than a [](https://nabtahealth.com/articles/top-10-gynaecologists/)[gynaecologist](https://nabtahealth.com/glossary/gynaecologist/). In fact, even once diagnosed, the best approach may well be to consult a multidisciplinary team of experts, depending on the specific symptoms you are experiencing. #### Looking after your emotional health It is also important to consider that [endometriosis](https://nabtahealth.com/glossary/endometriosis/) can have a large impact on your emotional wellbeing, and thus you need to manage more than just the physical symptoms of the condition. Chronic pain can be psychologically draining, as can putting on a ‘brave face’ in front of friends and family. It is not unusual for [](https://nabtahealth.com/articles/what-medications-are-recommended-for-endometriosis/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/) patients to report feeling isolated and alone and the condition has a strong association with depression. It is important to consult your doctor before these feelings start to overwhelm you. Your doctor should also be able to put you in contact with local support groups, where you will have the opportunity to talk to other women who are in the same position. #### Personalised treatment approach The wide ranging clinical presentation of [](https://nabtahealth.com/articles/how-is-endometriosis-diagnosed/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/) means that every patient ideally needs to have a [personalised treatment plan](https://nabtahealth.com/), tailored to their own requirements. This can take time to optimise, so in the early days after diagnosis, it might be necessary to see the doctor on a regular basis. As symptoms improve, the frequency of visits should subside. Nabta is reshaping [women’s healthcare](https://nabtahealth.com). We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Try Nabta’s [Cycle Monitoring with OvuSense](https://nabtahealth.com/product/cycle-monitoring-with-ovusense/) and understand your cycle and health. Get in [touch](/cdn-cgi/l/email-protection#dca5bdb0b0bd9cb2bdbea8bdb4b9bdb0a8b4f2bfb3b1) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * _[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) FAQs_. [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) UK, [https://www.](https://www.endometriosis-uk.org/endometriosis-faqs)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-uk.org/[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-faqs. * _Overview: [Endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/endometriosis/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/. Page last reviewed: 18/01/2019.
What Medications are Recommended for Endometriosis?
Medication for [endometriosis](https://nabtahealth.com/glossary/endometriosis/), the most common [symptom](https://nabtahealth.com/the-symptoms-of-endometriosis/) of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is pain, with up to 80% of patients complaining of period pain and up to 50% experiencing chronic pelvic pain. Aside from the physical discomfort and day-to-day limitations that long-term, chronic pain causes, it can also massively impact a patient’s quality of life, potentially leading to psychological conditions including anxiety and depression. The anxiety can be exacerbated in those patients who experience heavy periods every month, which causes additional discomfort and worry. #### Painkillers The first line approach for managing the symptoms of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) are over-the-counter painkillers. Non-steroidal anti-inflammatories ([NSAIDs](https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids)), such as ibuprofen, partly function by inhibiting the production of [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/). [Prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) cause the [uterus](https://nabtahealth.com/glossary/uterus/) to contract during [menstruation](https://nabtahealth.com/articles/menopause-the-symptoms-nobody-talks-about/) and this contributes to the [period pain](https://nabtahealth.com/articles/what-is-period-pain/) experienced by patients with _[endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. Reducing the levels of [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) will reduce the painful [contractions](https://nabtahealth.com/glossary/contraction/). Codeine-based medications and paracetamol-containing products are other options for pain relief. #### Hormone treatment If painkillers do not provide sufficient relief from the symptoms of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) there is the option of hormonal treatment. This is not a suitable option for those who are seeking help for [infertility](https://nabtahealth.com/glossary/infertility/). The endometrial deposits that develop outside the [uterus](https://nabtahealth.com/glossary/uterus/), and are characteristic of the condition, form in response to the hormone [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Hormonal therapy aims to block or reduce the production of [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Frequently prescribed hormonal therapies include the [combined contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/), [progesterone](https://nabtahealth.com/glossary/progesterone/) pills and gonadotrophin releasing hormone (GnRH) analogues: * The combined pill contains [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/); it prevents [](https://nabtahealth.com/articles/is-oligo-ovulation-anovulation-a-symptom-of-pcos/)[ovulation](https://nabtahealth.com/glossary/ovulation/) and makes periods lighter and less painful. * [Progesterone](https://nabtahealth.com/glossary/progesterone/) suppresses the growth of endometrial tissue, reducing [inflammation](https://nabtahealth.com/glossary/inflammation/) and pain. * GnRH analogues block [oestrogen](https://nabtahealth.com/glossary/oestrogen/) production, causing the endometrial tissue to shrink and become inactive. These drugs place the body into a temporary [menopausal](https://nabtahealth.com/i-am-post-menopause/) state, and long term use may require further medication to combat [](https://nabtahealth.com/articles/effects-of-menopause-on-the-body/)[menopause](https://nabtahealth.com/glossary/menopause/)\-associated symptoms, such as [hot flushes](https://nabtahealth.com/glossary/hot-flushes/) and bone density loss. #### Alternative options Medication is just one option for the treatment of [endometriosis](https://nabtahealth.com/glossary/endometriosis/). If symptoms persist, another option to consider is [surgery](https://nabtahealth.com/should-i-have-surgery-for-endometriosis/). A fully personalised treatment approach is recommended for each patient, taking into account their age, symptoms, [fertility](https://nabtahealth.com/product/fertility-selfcare/) status and family situation. Nabta is reshaping [women’s healthcare](https://nabtahealth.com/). We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, [pregnancy](https://nabtahealth.com/articles/pregnancy-symptoms/), and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#225b434e4e43624c434056434a47434e564a0c414d4f) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bulletti, C, et al. “[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) and [Infertility](https://nabtahealth.com/glossary/infertility/).” Journal of Assisted Reproduction and Genetics, vol. 27, no. 8, 25 June 2010, pp. 441–447., doi: 10.1007/s10815-010-9436-1. * [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) Treatment. [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) UK, [www.](http://www.endometriosis-uk.org/endometriosis-treatment)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-uk.org/[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-treatment. * [Endometriosis](https://nabtahealth.com/glossary/endometriosis/). Mayo Clinic, 24 July 2018, [https://www.mayoclinic.org/diseases-conditions/](https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/diagnosis-treatment/drc-20354661. * Treatment: [Endometriosis](https://nabtahealth.com/glossary/endometriosis/). NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/endometriosis/treatment/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/treatment/. Page last reviewed: 18/01/2019.