Most women have good long-term outcomes when they have an early referral to a women's health clinic and receive care from a medical team with specialist training in endometriosis. For example, doctors, gynaecologists, surgeons with advanced laparoscopy skills, and pelvic floor physiotherapists. Treatment may include pain-relief medicines, hormone therapy, non-hormone treatments, surgery and combined treatments.
Ask your doctor or specialists about the best treatments for you.
Your doctor may recommend pain-relief medicines, such as paracetamol and non-steroidal anti-inflammatory drugs (e.g. ibuprofen) for temporary relief.
Hormone medicines for endometriosis include combined contraceptives, progestogens and Gonadotrophin-releasing hormone analogues (GnRHa).
Hormone therapy may reduce the pain and severity of the endometriosis by suppressing the growth of endometrial cells and stopping any bleeding. But symptoms can return if you stop the treatment.
Hormone therapy isn’t suitable for women who want to get pregnant, and most treatments have side effects.
The combined oral contraceptive pill (COCP) is taken continuously by skipping the sugar (hormone-free) pills.
The continuous pill:
The pill also provides contraception if needed. But you don’t need to be sexually active to take the pill.
Possible side effects include:
Serious side effects, such as blood clots (thrombosis), are rare. If you experience chest pain, severe headaches, severe pain or swelling in your leg, see your doctor.
Your doctor may recommend you don’t take the pill if you:
Progestogens (natural and synthetic forms) provide pain relief for many women with endometriosis.
We don’t know exactly how progestogens relieve the symptoms of endometriosis. They may suppress the growth of the endometrial tissue, causing it to gradually shrink and disappear.
You can take progestogens as a daily pill, or you may choose a long-acting option such as an injection or IUD (intrauterine device).
Possible side effects include:
GnRHa treatment is usually used for moderate to severe endometriosis.
The GnRHa agonists stop ovulation, which results in reduced oestrogen hormone levels. This suppresses the growth of the endometrial tissue, causing it to gradually shrink and disappear.
GnRHa treatment creates a temporary chemical menopause and there may be associated side effects.
GnRHa may also decrease bone density, but this can be completely reversed within 12 months of completing treatment. This side effect may increase your risk of osteoporosis. Talk to your doctor about having a bone density scan (DXA) before treatment. You can also have oestrogen therapy after treatment to alleviate menopause symptoms and stop bone loss.
Endometriosis usually goes away after menopause. While uncommon, it can return with the use of menopausal hormone therapy (MHT), especially if there is no progestogen component.
During the menopause transition, women with endometriosis are often advised to have combined MHT, even if they no longer have a uterus. This is because therapy with oestrogen alone may increase the risk of endometriosis symptoms returning, or cancer.
Some anti-depressant medicines are used to treat endometriosis. These medicines affect the central nervous system’s response to pain. But there is limited research to show this is an effective treatment for endometriosis.
There are different non-drug options for treating endometriosis, such as pelvic floor physiotherapy, psychology (specifically cognitive behavioural therapy) and diet, but few studies have evaluated the benefits.
Learn more about Living with endometriosis
Many women use natural therapies (complementary medicine and therapies) to manage symptoms of endometriosis, such as period pain and inflammation.
While these medicines and therapies are popular, there isn’t substantial research to prove their effectiveness.
Read more about Endometriosis and natural therapies.
Most surgery for endometriosis is performed via keyhole surgery (laparoscopy). The goal of surgery is to achieve the best outcome and reduce the need for more operations in the future.
The first operation offers the best chance of removing the endometrial tissue, minimising the development of adhesions and improving long-term outcomes. It’s important to choose a surgeon with advanced laparoscopic surgical skills to perform this operation.
These specialists have extensive experience in managing the condition, minimising complications and improving outcomes.
If endometriosis is in the bowel or bladder, other specialists (e.g. a urologist or colorectal surgeon) may be involved in the procedure.
Many studies have shown that surgery improves symptoms and overall quality of life for women with endometriosis .
Depending on your situation, your doctor may perform:
Make sure you understand the potential benefits and risks of each option before you make a decision.
A hysterectomy (removal of the uterus), and sometimes removal of the ovaries and tubes, may be performed in extreme cases. This surgery is usually performed when women have severe pain and have tried all other options to improve their symptoms. It should only be recommended to women who do not want to get pregnant in the future.
Most of the hysterectomies performed remove both fallopian tubes but leave the ovaries behind. This helps to prevent surgical menopause. If you experience symptoms of menopause after your operation, you can ask your doctor for a referral to a specialist clinic for early menopause management. One type of menopausal hormone therapy called Tibolone may be suitable, as it does not stimulate endometrial cells in the same way standard MHT does.
Surgery by laparoscopy is an effective way to treat endometriosis. But a combination of surgery and hormone therapy can improve outcomes.
Hormone therapy is sometimes used prior to surgery to shrink the endometriosis, and again after surgery.
Studies have shown there is a delay in endometriosis recurring if surgery is followed by treatment with GnRHa agonists, the pill or the Mirena® intrauterine device (IUD).
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at January 2023.
© Jean Hailes Foundation. All rights reserved. This publication may not be reproduced in whole or in part by any means without written permission of the copyright owner. Contact: email@example.com