As the cause of endometriosis is still not understood, no particular treatment will provide a permanent cure. The most suitable treatment for you will depend on many factors, including:
- your age
- whether you plan to have children
- the severity of the symptoms
- the extent of endometriosis
- your preference.
Treatment usually involves a combination of:
To find the right treatment for your particular situation, a referral to a gynaecologist who has a special understanding and skill in treating pelvic pain and endometriosis is recommended.
Healthy eating and keeping active are key ways to manage endometriosis. Some women with endometriosis often have a sensitised bowel and find avoiding certain foods helpful. Others find complementary therapies helpful, especially in managing pain.
Medications used in the management of endometriosis usually either relieve pain and inflammation or work on reducing the growth of the endometriosis itself and make your periods lighter. They are most useful for women who have Grade 1 or mild disease and who do not wish to get pregnant. Medications decrease the symptoms of endometriosis, but they do not cure it.
Pain-relieving medication: NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and mefenamic acid are commonly used for pain relief.
- There is no evidence that one particular NSAID is better than another.
- If the pain happens in cycles, start taking your NSAID the day before the pain is expected and continue taking it regularly while you have the pain (often 3 to 4 days).
- To better manage your pain, it is important to start pain relief medication early.
- NSAIDs can cause serious side effects such as stomach bleeding, increased risk of heart attacks and stroke and kidney problems. They are not suitable for everyone and are usually not recommended as a long-term treatment. Check with your doctor or pharmacist if NSAIDs are suitable for you. Read more about NSAIDs.
There are many different hormone treatments which may be given as an injection, tablets or an intrauterine device (IUD). Common examples include the combined oral contraceptive pill (COCP), medroxyprogesterone acetate tablets (Provera), norethisterone tablets (Primolut N), medroxyprogesterone injection (Depo Provera) and levonorgestrel (Mirena). Most of these hormone treatments stop you from becoming pregnant. It is very important to discuss your plans about pregnancy with your doctor.
- combined oral contraceptive pill (COCP)
- It works by stopping ovulation and the hormone fluctuations associated with it, and in this way makes your periods lighter and less painful.
- It is best to take the COCP as 3 packets back-to-back. Take the hormone pills (or active pills) every day continuously for 3 months. Miss the 7 days of placebo tablets between each month. You can take a 7-day hormone free break between 3 monthly packets, but if you get breakthrough bleeding, reduce the hormone free break from 7 days to 4 days.
- medroxyprogesterone acetate tablets (Provera)
- These are taken every day for 3 months, with a one week break between 3-monthly cycles, to allow for a withdrawal bleed. Read more about medroxyprogesterone acetate tablets.
- norethisterone tablets (Primolut N)
- These are taken every day for 3 months, with a one week break between 3-monthly cycles, to allow for a withdrawal bleed. Read more about norethisterone tablets.
- medroxyprogesterone injection (Depo-Provera)
- Depo-Provera injection is usually given every 2 weeks, for at least 6 months.
- levonorgestrel or Mirena
- Also called an intra-uterine device (IUD)
- This is a small T-shaped device placed inside the uterus. It slowly releases small amounts of the hormone progesterone. Read more about Mirena.
- goserelin (Zoladex)
- This is given as an injection and is usually used when other medicines like the COCP or progestins cannot be used or they did not work well enough.
Some women may find the use of complementary therapies helpful to manage the pain caused by endometriosis, but evidence for their use is lacking. Examples of complementary therapies include relaxation techniques such as breathing techniques, meditation, T'ai Chi and yoga. Tell your doctor if you are using complementary therapies. Together you can discuss any benefits of using complementary therapies and check interactions with your conventional medicine or treatment and any safety concerns. Read more about considerations if you are using complementary and alternative medicines.
Surgery is usually needed for more severe endometriosis, to reduce symptoms and improve the chance that your fertility will not be affected.
Laparoscopic surgery as mentioned above is the only certain way to diagnose endometriosis; endometrial tissue is usually removed at the same time. The aim is to remove all endometriosis lesions, cysts and adhesions, and restore normal anatomy. As with all surgery, there is an element of risk, which should be discussed with your surgeon.
Laparoscopic surgery for endometriosis is a specialised area of gynaecology and surgeons who perform these operations have usually had special training in this area.
Hysterectomy and oophorectomy
A hysterectomy is a procedure to remove the uterus and cervix and is sometimes recommended in severe cases of long-standing painful and extensive endometriosis.
Removal of one or both ovaries (oophorectomy) may be considered also if they have been damaged with cysts (endometrioma).
However, if both ovaries are removed, symptoms of menopause will usually be experienced immediately or very soon after surgery. Hormone replacement therapy (HRT) may be recommended and will depend on factors such as age, medical history and personal choice.
While symptoms of endometriosis are often eliminated or helped by hysterectomy, it does not cure the disease. To help prevent symptoms continuing, it is essential the endometriosis is removed at the same time as the hysterectomy.
Discuss surgical procedures thoroughly with your specialist. Sometimes symptoms persist even after major surgery and will require thorough review to find the cause.