What are the treatment options for endometriosis?

Endometriosis is relatively common, believed to affect approximately 10 percent of women of reproductive age worldwide, though some estimates are higher. The condition occurs when tissue similar to the lining of the womb grows outside the womb. The tissue that lines the womb is called endometrium. The tissue that grows outside the womb is called endometriosis.

Endometriosis is most commonly found in the ovaries, the connective tissues that support the uterus, and other tissues in the abdomen and pelvis. Endometriosis can also attach and implant on the fallopian tubes, intestines, and other structures and spaces in the pelvic region. In rare cases, endometriosis tissue is found in more distant areas, such as the membranes that cover the lungs.

This condition is often painful, can disrupt many areas of a person’s life, and is associated with infertility. It is also associated with a number of coexisting conditions, including gastrointestinal disorders, chronic pain, chronic fatigue, and migraines.

While endometriosis is relatively common, it is not well understood. Healthcare researchers do not know what causes endometriosis or why some people have endometriosis and others do not. Though awareness about this condition has improved, diagnosis is often delayed, and the literature around the condition is filled with stories of people who have lived with painful symptoms for years before receiving an accurate diagnosis.

Medications that treat endometriosis

There is no known cure for endometriosis, but there are treatments that can help reduce symptoms, slow disease progression, and prevent complications. Medications are commonly used in treatment.

Pain-relief medication

Relieving pain is a priority in treatment. A healthcare provider may recommend taking an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen, or they may prescribe pain-relieving medications specifically for endometriosis. While these drugs can help reduce pain, they do not halt, shrink, or prevent the growth of endometriosis.

Hormonal contraceptives

Also called hormonal birth control, hormonal contraceptives are a common initial therapy for endometriosis. Examples include pills, injections, patches, vaginal rings, and intrauterine devices that contain a combination of estrogen and progestin, or progestin only.

In addition to preventing pregnancy, hormonal contraceptives regulate the hormones that stimulate the growth of endometrial tissue inside the uterus and endometriosis-associated tissue outside the uterus. These medications can help control menstrual bleeding and pain. Women who are taking hormonal contraceptives to treat endometriosis often take them continuously, skipping menstruation.

GnRH analogs

Gonadotropin-releasing hormone agonists and antagonists (GnRH analogs) may be recommended if other treatment options are not effective. GnRH is a hormone that signals the ovaries to produce estrogen and progesterone—hormones that can stimulate the growth of endometriosis tissue.

Medications that interfere with the normal regulation of GnRH lower the amount of estrogen and progesterone. This induces a temporary menopause-like state and can shrink endometriosis tissue and lessen symptoms.

Other types of hormone therapy

Other types of hormone therapy may be used to lower levels of estrogen and progesterone. These include drugs that mimic the activity of the hormone testosterone and a medication that is a combination of GnRH analog, estrogen, and progestin.

GnRH analogs and other types of hormone therapy cannot be taken continuously due to the risk of side effects, and treatment usually begins with a trial period of several months.

Several medications used to treat endometriosis come with safety-related warnings (box warnings). Always talk to your healthcare provider about the risk of side effects, how to use a medication properly, and how to monitor for side effects while on a medication.

Surgery for endometriosis

Surgery and other procedures are an effective treatment for moderate-to-severe endometriosis and may be able to improve fertility. Surgery can include:

• A surgical biopsy used to confirm a diagnosis. This involves removing endometriosis tissue and sending it to a lab for examination.
• Surgery to remove deeply implanted and/or larger endometriosis growths, and in some cases, organs that have been damaged by endometriosis.
• During surgery, a special tool may be used to destroy endometriosis tissue with intense heat.

Procedures are often performed as laparoscopic surgery (with small incisions and a camera), but the type of surgery will depend on a number of factors, including the location and size of the growths. Endometriosis can return after surgery, so hormonal treatment is often prescribed as well.

As with medications, risk, benefits, and potential side effects should be discussed with a healthcare team before surgery.