Medications or surgical interventions are frequently used to treat endometriosis. The course of action you and your doctor take will be determined by the severity of your signs and symptoms, as well as whether or not you intend to become pregnant. Doctors typically recommend that patients try conservative treatment approaches first, with surgery as a last resort if the conservative treatment approaches fail.
If you have painful menstrual cramps, your doctor may prescribe over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, and others) or naproxen sodium (Aleve), to help alleviate painful menstrual cramps. Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that reduce inflammation and relieve pain. If you are not trying to conceive, your doctor may recommend hormone therapy with pain relievers to relieve your symptoms.
As long as you are not trying to conceive, if you have endometriosis, the primary treatment involves reducing or controlling the amount of estrogen your body produces to make your periods less severe. Hormonal birth control pills can help to alleviate the discomfort. Your doctor may prescribe gonadotropin-releasing hormone (GnRH) agonists, which will prevent your menstrual cycle from occurring and reduce the amount of estrogen produced by your body. If you’re trying to get pregnant, on the other hand, you’ll require estrogen and other hormones. Infertility can be treated with a variety of methods.
Supplemental hormones can be effective in reducing or eliminating the pain associated with endometriosis in some cases. Endometrial implants thicken, break down, and bleed due to the fluctuating levels of hormones that occur during the menstrual cycle. Hormone therapy may help slow the growth of endometrial tissue and prevent the formation of new endometrial tissue implants. Hormone therapy does not provide a long-term solution for endometriosis. Your symptoms may return after you have stopped taking the medication.
Therapies used to treat endometriosis include:
Hormonal contraceptives are a type of contraception that uses hormones to keep a woman from getting pregnant. Birth control pills, patches, and vaginal rings are all effective methods of regulating the hormones that cause the buildup of endometrial tissue every month. When women use a hormonal contraceptive, they often notice that their menstrual flow is lighter and shorter. In some cases, using hormonal contraceptives — particularly continuous-cycle regimens — can help to reduce or eliminate pain.
Agonists and antagonists of gonadotropin-releasing hormone (Gn-RH) have been identified. They work by inhibiting the production of ovarian-stimulating hormones, which lowers estrogen levels and prevents menstruation from occurring. The endometrial tissue shrinks as a result of this. A low dose of estrogen or progestin is taken in conjunction with Gn-RH agonists, and antagonists may help reduce menopausal side effects such as hot flashes, vaginal dryness, and bone loss because these medications cause artificial menopause. After you stop taking the medication, you will resume your menstrual periods and become pregnant.
Progestin therapy is prescribed. Menstrual periods and the growth of endometrial implants can be stopped with a variety of progestin therapies. These include an intrauterine device containing levonorgestrel (Mirena, Skyla), a contraceptive implant (Nexplanon), a contraceptive injection (Depo-Provera), and a progestin pill (Camila). These treatments can alleviate the signs and symptoms of endometriosis.
Medications that inhibit the production of aromatase. Inhibitors of the aromatase enzyme are a class of medications that reduce the amount of estrogen in your body. Your doctor may prescribe an aromatase inhibitor in conjunction with a progestin or a combination hormonal contraceptive to treat endometriosis.
The use of conservative surgery to remove endometriosis implants while preserving the uterus and ovaries (conservative surgery) may increase your chances of becoming pregnant if you have endometriosis and are attempting to conceive due to the condition. If you are experiencing severe endometriosis pain, you may also benefit from surgery; however, endometriosis and pain may recur after surgery.
The procedure may be performed laparoscopically rather than through traditional abdominal surgery, which is less common. Even in severe cases of endometriosis, laparoscopic surgery can be used to treat the majority of patients.
In laparoscopic surgery, your surgeon makes a small incision near your navel and inserts a slender viewing instrument (laparoscope) before inserting instruments to remove endometrial tissue through another small incision. To alleviate pain following surgery, your doctor may recommend that you take hormone medication.
Endometriosis can make it difficult to conceive a child. If you have trouble conceiving, your doctor may suggest that you undergo fertility treatment under the supervision of an experienced fertility specialist. Fertility treatment can range from simply stimulating your ovaries to produce more eggs to in vitro fertilization and everything in between. Your circumstances determine the treatment that is most appropriate for you.
Hysterectomy with removal of the ovaries
Surgery to remove the uterus (hysterectomy) and ovaries (oophorectomy) were once thought to be the most effective treatment for endometriosis, but this has since been proven to be ineffective. In recent years, however, endometriosis experts have shifted their focus from this approach and instead on the careful and thorough removal of all endometriosis tissue.
Menopause occurs as a result of having your ovaries removed. Some people report relief from endometriosis pain due to the absence of hormones produced by the ovaries, but for others, endometriosis that remains after surgery continues to cause symptoms. Early menopause is also associated with an increased risk of heart and blood vessel disease (cardiovascular disease) and certain metabolic conditions and premature death.
As an alternative to becoming pregnant, hysterectomy is used to treat the signs and symptoms of endometriosis, such as heavy menstrual bleeding and painful menses due to uterine cramping, in women who do not want to become pregnant. However, this procedure is not always recommended. Even if the ovaries are left in place, a hysterectomy may still have a negative impact on your health in the long run, primarily if the surgery is performed before the age of 35.
Whether managing your endometriosis or treating it, finding a doctor with whom you are comfortable is essential. You may want to seek a second opinion before beginning any treatment to ensure that you know all of your options and the potential outcomes.
IVF and Endometriosis
According to RESOLVE, infertility treatments and success rates for women suffering from endometriosis-related and unexplained infertility are generally similar. In vitro fertilization (IVF) may be the best treatment option for both of these types of infertility. Women’s ovaries are stimulated to produce multiple eggs during in vitro fertilization (IVF). In a laboratory setting, the eggs are fertilized with the male partner’s sperm. As soon as the fertilized eggs develop into embryos, they are transferred to the woman’s uterus, where they can implant and possibly develop into a baby.
IVF eliminates the possibility of having blocked fallopian tubes or scar tissue in the uterus, preventing sperm from reaching an egg when the egg is released. Laparoscopy is usually not required when using in vitro fertilization (IVF). According to the Eunice Kennedy Shriver National Institute of Child Health and Human Development, having more than one laparoscopic surgery is not the best approach if you plan to use in vitro fertilization. Additional surgery may deplete your ovarian reserve, making IVF less likely to be successful in the future.
Mifepristone (Mifeprex), aromatase inhibitors (such as letrozole [Femara], anastrozole [Arimidex], and exemestane [Aromasin]), Chinese herbal medications, gestrinone (a 19-nortestosterone derivative with antiprogestational and antiestrogenic properties; currently unavailable in the United States), immunomodulators (such as pentoxifylline [Trental] and Acupuncture has also been shown to be effective in the treatment of pain in some studies.
While there is no cure for endometriosis yet, there are treatment options available that can help alleviate symptoms. In addition, as research into the condition, treatment options, and management continue, more options will be available shortly.
Contact your doctor if you’re interested in finding out more information. In addition to answering your questions, they can direct you to additional resources.