There is no cure for endometriosis and it can be difficult to treat. The aim of treatment is to ease the symptoms so that the condition does not interfere with your daily life.
Treatment will be given to relieve pain, slow the growth of endometriosis, improve fertility and prevent the disease from coming back.
Deciding which treatment
Your gynaecologist will discuss the treatment options with you and outline the risks and benefits of each.
When deciding which treatment is right for you, there are several things to take into consideration, including:
- your age
- whether your main symptom is pain or difficulty getting pregnant
- whether you want to become pregnant (some treatments may stop you getting pregnant)
- how you feel about surgery
- whether you have tried any of the treatments before
Treatment may not be necessary if your symptoms are mild and you have no fertility problems. In about a third of cases, endometriosis gets better by itself without treatment.
One course of action is to keep an eye on symptoms and decide to have treatment if they get worse.
Support from self-help groups can be very useful if you are learning to manage endometriosis.
Pain medication
Non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen and naproxen, are usually the preferred painkiller used to treat endometriosis. This is because they act against the inflammation (swelling) caused by endometriosis, as well as helping to ease pain and discomfort. It is best to take NSAIDs the day before (or several days before) you expect the period pain.
Paracetamol can be used to treat mild pain. It is not usually as effective as NSAIDs, but may be used if NSAIDs cause any side effects, such as nausea, vomiting and diarrhoea.
Codeine is a stronger painkiller that is sometimes combined with paracetamol or used alone if other painkillers are not suitable. However, constipation is a common side effect, which may aggravate the symptoms of endometriosis.
For more information, read the Endometriosis UK factsheet on pain management for endometriosis.
Hormone treatments
The aim of hormone treatments is to limit or stop the production of oestrogen in your body. This is because oestrogen encourages endometriosis to grow and shed. Without exposure to oestrogen, the endometriosis tissue can be reduced, which helps to ease your symptoms. However, hormone treatment has no effect on adhesions ('sticky' areas of endometriosis, which can cause organs to fuse together) and cannot improve fertility.
Read more about adhesions and other complications of endometriosis.
Hormone treatments stop the production of oestrogen by putting you in either an artificial state of pregnancy or an artificial state of menopause, which stops your periods.
Once your periods have stopped, the endometriosis is no longer aggravated. However, it is important to note that most of these treatments are not contraceptives.
There are four broad types of hormone-based treatment:
- progestogens
- antiprogestogens
- the combined oral contraceptive pill
- gonadotrophin-releasing hormone (GnRH) analogues
Progestogens
Progestogens are synthetic hormones that behave like the natural hormone progesterone. They stop eggs from being released (ovulation), which can help to shrink endometriosis tissue. However, they can have side effects such as bloating, mood changes, irregular bleeding and weight gain.
Drug names include medroxyprogesterone acetate, dydrogesterone and norethisterone.
The Mirena intrauterine system, a T-shaped contraceptive device that fits into the womb and releases progestogen, has been successfully used for the treatment of endometriosis.
Read more about the intrauterine system.
Antiprogestogens
Also known as testosterone derivatives, antiprogestogens are synthetic hormones that bring on an artificial menopause by decreasing the production of oestrogen and progesterone. Side effects can include weight gain, acne, mood changes and the development of masculine features (hair growth and deepening voice).
Drug names include danazol and gestrinone. Gestrinone has fewer unpleasant side effects.
The combined oral contraceptive pill
The combined contraceptive pill contains the hormones oestrogen and progestogen. Although it is not officially licensed for the treatment of endometriosis, the pill can help relieve milder symptoms and can be taken over long periods of time. It stops the function of the ovaries, which in turn stops the menstrual cycle.
The pill can have side effects, but you can try different brands until you find one that suits you.
Gonadotrophin-releasing hormone (GnRH) analogues
Like antiprogestogens, GnRH analogues are synthetic hormones that cause an artificial menopause. They are taken as a nasal spray, implant or injection and work in a similar way to gonadotrophin-releasing hormone (a natural female hormone).
When you take GnRH analogues continuously for more than two weeks the production of oestrogen is stopped. They often have side effects such as hot flushes, vaginal dryness and low libido, so they are recommended alongside hormone replacement therapy (HRT), which is usually used to reduce the symptoms of menopause.
Drug names include buserelin, goserelin, nafarelin, leuprorelin and triptorelin.
Surgery
Surgery can be used to remove or destroy areas of endometriosis tissue, which can help improve symptoms and fertility. The kind of surgery you have will depend on where the tissue is. The options are:
Any surgical procedure carries risks. Discuss them with your surgeon.
Laparoscopic surgery
During a laparoscopy (a surgical procedure to gain access to the inside of your pelvis), endometriosis tissue can be destroyed or cut out using delicate instruments that are inserted into the body. This is also known as keyhole surgery.
Laparoscopy is now commonly used to diagnose and treat endometriosis. All grades of endometriosis can be successfully treated with this minimally invasive technique (where only small cuts are needed to insert the instruments). Heat, a laser or an electric current may be applied to destroy the patches of tissue.
Ovarian cysts or endometriomas, which are formed as a result of endometriosis, can also be easily treated using this technique, which can be used alongside medication such as GnRH analogues.
Although this kind of surgery can relieve your symptoms, they can sometimes recur, especially if some endometriosis tissue is left behind at the time of surgery.
Laparotomy
This is major surgery that is used if your endometriosis is severe and extensive. Recovery time is longer than that for keyhole surgery. The surgeon makes a wide cut along the bikini line and opens up the area to access the affected organs and remove the endometriosis tissue.
Hysterectomy
If keyhole surgery and other treatments have not worked and you have decided not to have any more children, a hysterectomy (removal of the womb) can be an option. However, this is rarely required.
A hysterectomy is a major operation that will have a significant impact on your body. Deciding to have a hysterectomy is a big decision, which you should discuss with your GP or gynaecologist. Hysterectomies cannot be reversed and there is no guarantee that the endometriosis will not return after the operation.
If the ovaries are left in place, the endometriosis is more likely to return.
The benefits of a healthy diet
Women with endometriosis may also benefit from eating a healthy, balanced diet. The benefits of this may include:
- increasing ability to tolerate medical treatments
- increasing ability to deal with potential side effects of treatment
- increasing energy levels
- helping to regulate bowel movements
- helping to regulate sleep patterns
Read more information and tips about healthy eating and how to maintain a balanced diet.
Your GP may be able to refer you to a dietitian who can help you to put together a suitable diet plan.
