How to treat endometriosis

Endometriosis can cause severe pain due to trapped tissue and lesions forming outside of the uterus and womb. Over-the-counter (OTC) medications such as ibuprofen and naproxen can get to work quickly and help relieve some pain symptoms.

However, advanced treatment options such as medications, surgery, and natural remedies are sometimes necessary to provide a more effective and long-term solution.

Speaking with a healthcare professional about your symptoms is important to determine which treatment options may work for you.

Birth control pills

Birth control pills can help ease endometriosis symptoms and are one of the most common forms of treatment for the condition. They work by lowering estrogen levels and preventing or shortening your menstrual cycle.

The medication is available in two forms: progestin-only pills — also known as the minipill — and combined contraceptive pills.  

Combined contraceptive pills contain estrogen and progestin. They can help lessen pain associated with heavy and painful periods.

Examples of combined contraceptive pills include:

• Dasetta
• norethindrone (Camila)
• levonorgestrel (Aviane)

The minipill contains only progestin and can help to reduce heavy menstrual bleeding and pelvic pain.  

Examples of progestin-only pills include norethindrone and desogestrel.

Taking birth control pills can cause side effects such as:

• breast tenderness
• nausea
• irregular bleeding, such as spotting between periods
• mood changes

It’s important to speak with a doctor or healthcare professional to determine if birth control pills are the best option for you in relieving endometriosis pain.

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GnRH (gonadotropin-releasing hormone) agonists

GnRH agonists work by stopping estrogen production in your body and preventing ovulation and menstruation from occurring. They can even be effective in stopping further endometrial growth.

Recent studies have found that GnRH agonists can help ease severe pelvic pain and provide a symptom-free period for up to 12 months.

Examples of GnRH agonists include Lupron (leuprorelin) and Decapeptyl (triptorelin).

They are available in the following forms:

• nasal spray
• injection, commonly delivered into a muscle or the abdominal wall
• pills

It’s important to know that taking GnRH agonists can invoke temporary symptoms of menopause. Other common side effects include:

• bone thinning when used for more than 6 months
• vaginal dryness
• mood changes
• hot flashes and sweats

If you choose to stop taking GnRH agonists, your symptoms of endometriosis may return.

Surgery

Surgery can be an effective option in treating and gaining a positive diagnosis of endometriosis, as the condition can be difficult to spot without seeing the inside of the abdomen.

It’s important to speak with a healthcare professional or doctor about whether surgery is the best option for you, as some treatments can permanently affect your ability to conceive.

Laparoscopy

Laparoscopy is one of the most common surgeries offered to people with endometriosis. It’s a minimally invasive procedure that can allow a surgeon to see into your abdomen and provide a confirmed diagnosis of endometriosis.

The surgery involves a small incision into your abdomen to insert a camera. At this point, a surgeon will decide whether to proceed based on the number of lesions and scarring. If they choose to continue, they will remove excess tissue and any adhesions.

It can provide relief to those who have previously not found medication to be effective in treating endometriosis pain and can offer a long-term solution in minimizing most symptoms in up to 70% of people.

Risks involved with laparoscopy can include:

• uncontrolled bleeding
• blood clots in legs or lungs
• severe pain at the incision site
• nausea and vomiting
• fever

It’s important to remember that laparoscopy is not a cure for endometriosis, and it is possible for excess tissue to regrow after surgery.

Laparotomy

Laparotomy is a major surgery given under general anesthesia and is not commonly offered to those with endometriosis immediately. However, a surgeon may suggest a laparotomy if your endometriosis is extensive and laparoscopy cannot remove it.

In this case, a laparotomy can effectively remove progressive scar tissue and lesions from organs such as your:

• fallopian tubes
• ovaries
• bladder

A laparotomy involves a larger incision and a much longer recovery time.

Hysterectomy 

A hysterectomy can help achieve a long-term treatment of endometriosis by providing relief of symptoms and stopping menstruation.

A 2020 study into the effectiveness of hysterectomies for endometriosis pain found a significant and long lasting reduction in pain symptoms after surgery.

It involves the partial or total removal of the uterus and can sometimes involve the removal of further organs.

There are three kinds of hysterectomies:

• partial hysterectomy — removal of the uterus
• total hysterectomy — removal of the uterus and cervix
• hysterectomy and salpingo-oophorectomy — removal of the uterus, cervix, one or both ovaries, and fallopian tubes

A doctor will only suggest a hysterectomy if your condition does not respond well to other treatments and you don’t plan on getting pregnant. This treatment option is often a rare and last-stage resort and has several risks including:

• lowered libido
• pain during sex
• vaginal dryness

You may also need hormone replacement therapy if the procedure includes the removal of your ovaries.

It’s important to remember that a hysterectomy is not a cure for endometriosis. For some people, symptoms will recur after surgery.

Alternative treatments

Several alternative options are available to help manage symptoms of endometriosis naturally, such as acupuncture and following an anti-inflammatory diet. You can use many of these remedies alongside medication and surgery for endometriosis. However, it’s important to check with a healthcare professional to know when it is safe to do so.

Acupuncture

Acupuncture is a form of traditional Chinese medicine involving the insertion of needles into target areas of the body, which can help to stimulate your nervous system.

A 2020 study found acupuncture to be an effective remedy for endometriosis, resulting in decreased pain levels and an overall better quality of life with manageable symptoms. The study also showed less clotting within the first few days of previously heavy menstrual cycles.

Anti-inflammatory diet

Following an anti-inflammatory diet can help reduce pain symptoms associated with endometriosis. Certain foods can worsen inflammation around areas with excess endometrial-like tissue, so the right diet can help decrease pain and balance your body’s estrogen levels.

Anti-inflammatory foods that help with endometriosis symptoms include:

• whole grains — found in rice and oats
• healthy fats — found in avocados, fatty fish, and nuts
• fruits and vegetables

Many people with endometriosis find it helpful to start an elimination diet by tracking which foods trigger a flare-up when reintroduced. It can also help you recognize which foods may help you feel better and decrease symptoms of inflammation and pain.

Summary

There is currently no cure for endometriosis, but there are many ways in which you can find symptom relief and improve your overall quality of life.

Medical treatments and natural remedies can help decrease pain levels and inflammation and sometimes prevent symptoms from worsening. You can speak with a healthcare professional to determine what treatment options may work best for you to provide relief from endometriosis.

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