Endometriosis Treatment Overview

When to see a healthcare provider

You should always see a healthcare provider if you have symptoms of endometriosis, which include chronic abdominal or pelvic pain, pain during or after sex, heavy bleeding with your period, and painful or debilitating menstrual cramps that get worse over time. Even if your symptoms aren’t severe, it’s still important to get a diagnosis because endometriosis can lead to complications like ovarian cysts (endometriomas) and infertility.

Getting diagnosed

• Your doctor can often diagnose you based on your symptoms, a pelvic exam, and possibly imaging tests like ultrasound or MRI. But these tests cannot tell you with 100% certainty that you have endometriosis.
• The only diagnostic test is a laparoscopy. The doctor uses a scope to look for signs of endometrial tissue outside the uterus and tests the abnormal tissue to confirm endometriosis.

What to expect from your visit

Your treatment will depend on the severity of your symptoms. Mild to moderate pain is typically treated with:

• OTC pain relievers, including ibuprofen (Motrin, Advil) and naproxen sodium (Aleve).
• Your provider may prescribe continuous hormonal contraceptives, which contain estrogen and progestin. They’re available in several forms, like pills and a patch. If you can’t take estrogen, progestin-only pills may be prescribed instead. Endometriosis is driven by hormones, so changing your hormone levels can help relieve pain.
• Physical therapy can help relieve inflammation and other problems in the pelvis. Your physical therapist may do manual therapy, tissue mobilization, and biofeedback.

If your pain is severe or treatments don’t help, there are several options that may provide relief.

• Gonadotropin-releasing hormone (GnRH) analogs are a group of medications that reduce the production of estrogen and progesterone. These are prescribed with “add-back” hormonal therapy to reduce side effects, like hot flashes and vaginal dryness.
• Aromatase inhibitors block aromatase, the enzyme that converts hormones called androgens into estrogen. It may be prescribed if GnRH analog treatment is not effective. While doctors prescribe these medications for endometriosis, it is considered off-label, meaning it is not FDA approved for this condition.
• Elagolix (Orlissa), a relatively new medication, can help relieve pain by reducing estrogen. But it shouldn’t be taken for more than 2 years because it may cause side effects like hot flashes, night sweats, and lower bone density.
• Danazol may help with the pain from endometriosis but is less commonly prescribed because of its side effects (weight gain, swelling, voice deepening, and hair growth).
• Laparoscopy, which may be used to diagnose endometriosis, can also help treat it. Your doctor can remove endometrial tissue during the procedure.
• If none of the above treatments help, you may need a hysterectomy. This procedure can be performed with or without removing the fallopian tubes and ovaries.

Treating infertility caused by endometriosis

If endometriosis has caused infertility, there are treatments that may help you conceive. If you’re in the early stages of endometriosis (stages 1 or 2) and are under 35 years old, you can try:

• Six months of timed intercourse
• Less invasive fertility treatments, including ovulation induction and intrauterine insemination

For later stage endometriosis (stages 3 or 4) or women 35 years old or older with stage 1 or 2 endometriosis, options include:

• In vitro fertilization (IVF)
• Intracytoplasmic sperm injection
• Assisted reproductive hatching

Prescription endometriosis medications

• Continuous hormonal contraceptives
• Progestin-only pills
• Aromatase inhibitors: letrozole (Femara), anastrozole (Arimidex)
• GnRH analogs: goserelin (Zoladex), leuprolide (Lupron Depot, Eligard), nafarelin (Synarel)
• GnRH antagonist: Elagolix (Orlissa)

Types of endometriosis providers

• Your primary care provider can diagnose and treat endometriosis.
• An ob/gyn can help confirm the diagnosis and offer additional treatments, including surgery.
• A reproductive endocrinologist can treat infertility caused by endometriosis.

Treating endometriosis at home

Always see a healthcare provider—either your primary care provider or an ob/gyn—to get a diagnosis. Common symptoms of endometriosis include chronic abdominal or pelvic pain, pain during or after sex, heavy bleeing during your period, painful or debilitating menstrual cramps that get worse over time, and infertility.

In some cases, OTC medications and at-home strategies can help symptoms.

OTC medications

OTC antiinflammatory drugs (NSAIDs), like ibuprofen (Motrin, Advil) or naproxen (Aleve) can help menstrual cramps. It is important to check with a provider to make sure NSAIDs are safe for you to take.

Tips for treating endometriosis

• Endometriosis can be stressful. Make time for activities that help you relax. Stress reduction techniques like meditation, yoga, and deep breathing can also relieve tension.
• Prioritize sleep. Endometriosis can decrease the quality of your sleep. Create good sleep habits, like keeping your bedroom dark and quiet, and having a consistent bedtime and wake-up time.
• If endometriosis makes you nauseous, drinking ginger tea may help.
• Massage your pelvic muscles to release tension before your period starts.
• Place a hot water bottle or heating pad on your abdomen to reduce pelvic pain and cramping.
• Get support from caring family members and friends. Share your thoughts and feelings and let them know how they can help you.
• Consider joining a support group that meets online or in person. Examples include Endowarriors and Facebook groups like MyEndometriosisTeam.
• Consider alternative options to medicinal treatments, like osteopathic manipulative medicine, acupuncture, and diet changes.

Wellness and prevention

• Consider making changes to your diet. Some research shows that eating fewer foods that increase inflammation (red meat, pork) and more green vegetables, fruit, and omega-3 fatty acids may reduce pain symptoms around your period. Avoid processed foods, refined sugar, caffeine, and alcohol.
• Keep a food journal so you can see whether your symptoms improve or get worse based on what you eat.
• Stay active. Try to move at least 30 minutes a day. Endometriosis symptoms can make exercise challenging—low- to moderate-intensity activities like walking and swimming may be best.