Endometriosis - Treatment Overview

Treatment Overview

Although there is no cure for endometriosis, treatment can help with pain and infertility. Treatment depends on how severe your symptoms are and whether you have future pregnancy plans. For pain only, any hormone therapy that lowers your body's estrogen levels will shrink endometriosis implants and may reduce pain. To become pregnant, surgery, infertility treatment, or both may help.

Endometriosis symptoms, no pregnancy plans

If you have endometrial pain or bleeding and no immediate plans to become pregnant, birth control hormones (patch, pills, or ring) or anti-inflammatories (NSAIDs) may be all that you need to control pain. Birth control hormones help shrink endometrial tissue and reduce pain for most women. They are also likely to keep endometriosis from getting worse.⁷ Anti-inflammatories reduce bleeding, inflammation, and pain. Most women can use these medicines safely for the long term with few side effects.

If you have more severe symptoms or if birth control hormones and NSAIDs do not work, you might try a stronger hormone therapy such as therapy with a gonadotropin-releasing hormone agonist (GnRH-a), progestin, a progestin intrauterine device (Mirena), danazol, or aromatase inhibitors. Some doctors will first do a laparoscopy to look for signs of endometriosis in the pelvis. But many think this is not needed unless there is a chance that you have another problem.⁸

Should I use hormone therapy to treat endometriosis?

If hormone therapy does not work or if growths are affecting other organs, surgery to remove endometrial growths and scar tissue is the next step. This can usually be done through one or more small incisions, using laparoscopy. Some studies suggest that using hormone therapy after surgery can make the pain-free period longer by preventing the growth of new or returning endometriosis.⁷ Surgery relieves pain for a year or two in most women, although about 20% of women report no improvement after surgery.⁹

In severe cases, removing the uterus and ovaries (hysterectomy and oophorectomy) is an option. This surgery causes early menopause. It is reserved for women with no pregnancy plans who have had little relief with other treatments. But up to 15% of women continue to have pain after this major surgery.¹⁰

Should I have a hysterectomy and oophorectomy to treat endometriosis?

Infertility treatment

If you are having trouble becoming pregnant, treatment decisions for endometriosis may be more complex. The treatment you and your doctor choose may depend on how bad your endometriosis is, your age, your health in general, and other factors. Options to improve your chances of pregnancy include:

• Intercourse during the most fertile days of each menstrual cycle. If your endometriosis is not very bad, this may be all you need to try.
• Laparoscopic surgery. Surgical removal of endometriosis and scar tissue can improve pain and your chance for pregnancy. This is especially true for women with mild to moderate endometriosis.¹¹
• Superovulation medicine (clomiphene or gonadotropins) and intrauterine insemination. These are often used to treat infertility in women.
• In vitro fertilization. If surgery does not lead to pregnancy, in vitro fertilization can help improve your chances.

Using hormone therapy for endometriosis will not help with infertility. Hormone therapy for endometriosis prevents pregnancy. But some studies of women with severe endometriosis have found that 6 months of GnRH-a treatment before in vitro fertilization improves the chances of conceiving a successful pregnancy.¹¹

What To Think About

Not all women with endometriosis have pain, and endometriosis does not always get worse over time. During pregnancy, endometriosis usually improves, as it does after menopause. If you have mild pain, have no plans for a future pregnancy, or are near menopause (around age 50), you may not feel a need for treatment. The decision is up to you.

Pain recurrence after hormone therapy

After treatment with any hormone therapy, endometriosis pain can, but does not always, return. Pain is more likely to return with more severe endometriosis.