How is endometriosis treated?

Endometriosis treatment is normally administered through surgery or medications. The approach that is chosen is typically decided on according to your and your doctor’s suggestions. Your doctor will also assess the severity of your condition and whether you want to one day fall pregnant. Conservative approaches are generally the first option.

The following are the options of treatment for endometriosis:

Pain medication

It is likely that your doctor will first recommend some OTC (over-the-counter) pain medication, some of these may include:

• Ibuprofen (Advil, Motrin IB)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Naproxen (Aleve)

These medications usually help in easing the pain of menstrual cramps. If taking and these do not relieve your symptoms, then speak to your doctor about another approach to pain management.

Hormone therapy

Hormone supplements can help in eliminating or reducing the pain associated with endometriosis. The fluctuating levels of hormones when you have your menstrual period can result in the thickening of endometrial implants which cause endometriosis, these then shed and bleed. Through the use of supplemental hormones, this tissue growth may be slowed and new growth can be prevented.

Hormone therapy is not, however, a permanent solution as symptoms usually return when one stops treatment.

Hormone therapies that are used for the treatment of endometriosis include:

• Hormonal contraceptives – Medications for birth control including birth control pills, vaginal rings and patches can aid in controlling the hormones that are responsible for endometrial tissue building up every month. A lot of women will have a shorter and lighter menstrual flow when they are taking hormonal contraceptives. The use of these types of contraceptives, particularly ones that require a continuous regimen (such as birth control pills), can also help in reducing the pain associated with mild and moderate endometriosis.
  • There is also an option for an injection known as medroxyprogesterone (Depo-Provera), which has proven to be effective in stopping menstruation. This will also stop endometrial implants from growing, as well as relieve pain. This is often not your doctor’s first choice as there is risk associated with these hormones affecting your body’s bone production, weight gain and some symptoms of depression.

• Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists – If women take these hormones, they are able to block or stop the production of the hormones that stimulate your ovaries, this will lower your oestrogen levels and in turn, prevent menstruation. This will also result in your endometrial tissue shrinking as these drugs will create what is known as an ‘artificial menopause’ without the severe side effects of menopause, being vaginal dryness, bone loss and hot flushes. This is done through taking low doses of the hormones progesterone and oestrogen, as well as the Gonadotropin-releasing hormone (Gn-RH) agonists. When you stop this treatment, your fertility and periods will return.
• Progestin therapy – This is a form of contraception and can help relieve the symptoms of endometriosis, some examples include:
• The Mirena – This is an intrauterine device (IUD) which is inserted into your uterus to stop you from menstruating and falling pregnant for a number of years, this is often as many as five years. A Mirena contains the progestin hormone which will thicken the cervical mucus so that the sperm cannot reach the egg released from an ovary, this is what will also prevent ovulation and in turn menstruation in some women.
• A contraceptive implant (Nexplanon) – This is a small matchstick-size rod that is inserted into your arm. From here it will release hormones that will stop you from being able to fall pregnant.
• A contraceptive injection (Depo-Provera) – This injection is typically given every 12 weeks and contains the same hormone progestin which thickens the cervical mucus, preventing sperm from meeting an egg to fertilise it.
• **My Med Memo – The difference between progesterone and progestin is that progesterone is a natural hormone that our adrenal glands and ovaries produce. It forms an integral part in the balance of hormones in the body as it is necessary for an embryo to survive, as well affords a number of other biological benefits such as regulating the menstrual cycle and playing a role in sexual desire. Progestin is a synthetic hormone that is manufactured, in the above cases, it is used to prevent endometrial hyperplasia (the enlargement and growth of endometriosis) through hormone replacement therapy.
• Danazol – This is a drug that will suppress endometrial growth through blocking the production of hormones that stimulate the ovaries and lead to ovulation, thus preventing menstruation, as well as endometriosis symptoms. However, although rare, if you do ovulate and fall pregnant while taking this drug, there is a risk of it impacting the health of your baby.

Conservative surgery

If you are diagnosed with endometriosis and want to fall pregnant, then surgery (known as conservative surgery) that will attempt to remove the bulk of your endometriosis whilst also trying to preserve your uterus and ovaries, may be able to increase the chances of you falling pregnant.

If you are suffering from severe pain as a result of endometriosis, then surgery will also often be able to aid in easing the pain, however, this is not to say that the pain will not return in future if endometriosis recurs.

Conservative surgery in the more extensive and severe cases of endometriosis is traditionally done through abdominal surgery although it can also be done laparoscopically. When the surgery is done laparoscopically, the surgeon will make a small incision in your navel area where he or she will then insert a small viewing device known as a laparoscope, from this, the surgeon will make another small incision where he or she can insert instruments that will remove the endometrial tissue.

Abdominal surgery makes a larger incision in your abdomen to remove the endometrial tissue.

Assisted reproductive technologies

These include reproductive techniques that will help you to fall pregnant, these are sometimes preferred over conservative surgery or in cases where conservative surgery was unsuccessful. A popular technique includes In Vitro Fertilization (IVF), this is a fertilisation process that works through extracting your eggs and retrieving a sample of sperm from your partner or a donor, the eggs and sperm are then combined manually in a petri dish in a lab in order for an embryo to form. This will then be inserted into your uterus during an implantation procedure. A few samples are often taken and then inserted into the uterus which can result in twins or triplets. This can, however, often be a costly procedure.

Hysterectomy

When endometriosis is more severe, a hysterectomy will be conducted that will remove the cervix, ovaries and uterus, this is known as a total hysterectomy. There are different types of hysterectomies. Some of these include:

• A radical hysterectomy – The uterus as well as the tissues on the side of the uterus, the top part of the vagina and the cervix is removed (this is only conducted in chronic cases if there are cancer cells present).
• Hysterectomy with bilateral salpingo-oophorectomy (total hysterectomy) – This will remove the cervix, fallopian tubes, ovaries and fallopian tubes.

This surgery is often considered to be the last resort in the fight against endometriosis, particularly if you are still in your reproductive years as you will not be able to fall pregnant once this is done. 

This is a very intrusive and intensive surgery and requires a surgeon you will feel comfortable with and a solid, caring support structure thereafter. This will be your last resort if your endometriosis has gotten to a point where conservative surgery cannot remove it and you cannot manage to live with the symptoms.

Can endometriosis be treated at home?

Lifestyle changes and home remedies for endometriosis

If you find that your pain is persistent or that your medical treatment takes some time to take effect, then you may find the below home and lifestyle remedies to be effective in helping to relieve your discomfort:

• A heating pad, hot water bottle or warm baths will help in relaxing your pelvic muscles and in reducing pain and cramps.
• OTC (over-the-counter) nonsteroidal anti-inflammatory (NSAIDs) drugs can help in relieving the pain of cramping, such as:
  • Naproxen (Aleve)
  • Ibuprofen (Advil, Motrin IB)
• Regular exercise will also help to improve your symptoms.