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How Do You Treat Endometriosis?

Curated by Claudia Shannon / Research Scientist / ishonest

Currently, there is no cure for endometriosis. Treatment focuses on alleviating pain and preventing infertility. Potential treatments range from oral medications, like birth control pills, to surgical solutions, like laparoscopy. There are even alternative therapies for endometriosis.

To help determine the best treatment for you, your doctor will consider factors such as your:

  • pain level
  • desire to get pregnant
  • overall health
  • age

Overview

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Endometriosis is a chronic (long-term) disorder that can affect anyone with female reproductive organs. It occurs when tissue similar to the tissue that lines the uterus grows outside of the uterus, where it doesnt belong. Pain, ranging from mild to debilitating, is the most common symptom.

When you have endometriosis, the endometrial-like tissue growing outside your uterus is affected by the same hormonal changes that bring on menstruation. It grows thicker throughout your cycle and then breaks down and bleeds. This can lead to inflammation.

Over time, it can cause a buildup of scar tissue and adhesions that may interfere with fertility.

Treating endometriosis with medication

Medications, both prescription and over-the-counter (OTC) medications, can reduce inflammation and provide pain relief. If your pain level is low, OTC nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil/Motrin) and naproxen (Aleve) may be all you need to control your pain.

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But many people need additional medications or treatments to help improve their quality of life. Medications used to treat endometriosis include:

Birth control pills

Medications like birth control that help regulate hormones are among the most common endometriosis treatments. They help reduce the pain and cramping that happen around your period. They may also prevent the formation of new adhesions, though they cannot remove existing tissue.

Hormonal contraceptives work because they help regulate and stabilize estrogen and progesterone levels. When your hormones dont spike, endometrial tissue doesnt grow thicker and cause inflammation.

Many birth control pills are only taken 21 days a month, followed by 7 days of placebo (sugar) pills. For endometriosis, doctors often recommend a continuous- cycle option without placebo pills. Eliminating the placebo days keeps hormone levels even more stable.

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Birth control pills typically shorten and lighten your periods. Continuous-cycle pills can also be used to reduce the number of periods you have annually or to stop them completely.

Birth control pills are a good option for people who plan on getting pregnant in the near future, as they can be easily discontinued.

IUDs and other hormonal contraceptives

Hormonal birth control only reduces endometriosis symptoms while youre using it. If you stop using it (or forget to take your pill regularly), your symptoms will most likely come back.

For a more dependable, long-term solution, you may want to consider other hormonal contraceptives. IUDs that contain progestin, such as Mirena, are a great option.

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Hormonal IUDs work the same way as birth control pills to stop endometrial tissue from thickening. They can reduce cramps and make your period much lighter. Some people stop getting their period altogether.

Hormonal IUDs last for several years and can be removed if you decide to get pregnant.

Other hormonal contraceptive options include:

  • birth control implant
  • progestin injections (Depo-Provera shot)
  • birth control patch
  • vaginal ring
GnRH (gonadotropin-releasing hormone) agonists

GnRH agonists prevent your ovaries from making estrogen. This stops ovulation, menstruation, and the hormonal cycle that exacerbates endometriosis.

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GnRH agonists are available as a nasal spray or injection. They are also available in pill form.

These medications can cause many of the unpleasant side effects common during menopause, including:

  • hot flashes
  • sleep disturbances
  • mood swings
  • vaginal dryness

They can also lead to bone loss and other complications if taken long term.

Danazol

Danazol is a synthetic steroid that mimics testosterone, a male reproductive hormone. This drug, taken in pill form, stops ovulation from occurring. You may have very few or no menstrual cycles while youre on this drug.

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Danazol may cause masculinization side effects, such as a deepening of your voice. It can also harm a developing fetus. You should not take this medication if you are or might become pregnant.

Surgery for endometriosis

Endometriosis surgery can be done to both confirm a diagnosis and treat the disease.

The benefits of surgery may be temporary or permanent. Before you consent to any procedure, talk with a doctor about whether you have a desire for future pregnancy. Some procedures will make pregnancy more likely to occur. Others will eliminate your ability to conceive and carry a baby.

Laparoscopy

A laparoscopy is a minimally invasive surgical procedure that allows your doctor to see inside your abdomen with a tiny camera. It is the gold standard for diagnosing endometriosis. It can also be used to treat the disease.

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During a diagnostic laparoscopy, a small incision is made in your abdomen, and a thin tube with a camera at its tip is inserted into it. This allows your doctor to see how advanced your endometriosis is.

If your surgeon chooses to proceed with treatment, they will remove excess tissue through another small incision. They may also destroy scar tissue and adhesions.

Removing this tissue may make it easier for you to conceive. It may also reduce your pain level.

Laparoscopy may be a good option for you if your symptoms dont improve with medication alone. It is not a cure for endometriosis. Endometrial tissue often grows back over time.

Other surgical options
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Other surgical treatments for endometriosis are much more aggressive. For this reason, they arent as common as they used to be. Examples include:

  • Laparotomy. This major surgical procedure is sometimes done to remove endometrial and scar tissue. Because it involves large incisions and an extensive recovery, its not common.
  • Hysterectomy. This is the surgical removal of the uterus. While it may reduce pain in those who dont plan on carrying children, it can have adverse health consequences in younger people.
  • Oophorectomy. This is the surgical removal of the ovaries. It may help improve symptoms, but it brings on early menopause. Early menopause carries its own health risks.

Treating infertility

Some people with endometriosis have difficulty becoming pregnant. Patches of endometrial tissue can:

  • block the fallopian tubes
  • damage the ovaries
  • alter the pelvic environment

For many people, a laparoscopy with tissue removal is enough to restore fertility. If you dont get pregnant after surgery, your doctor may recommend additional fertility treatments.

Fertility drugs and IUI

Fertility medications, like clomiphene and gonadotropins, are sometimes used to stimulate the ovaries. They encourage ovulation and help prepare the body for pregnancy. Clomiphene is taken as a pill for about 5 days during each cycle, while gonadotropins are taken by injection.

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In people with more advanced endometriosis, fertility drugs are often combined with intrauterine insemination (IUI).

IUI is a type of artificial insemination performed in a doctors office. Using a sperm sample from a partner or donor, your doctor will place the sperm directly into your uterus.

In vitro fertilization (IVF)

IVF is a form of assisted reproductive technology designed to help you get pregnant. The process involves many steps, including:

  • Taking hormonal medications that help you produce many eggs.
  • Having your eggs removed through a minor outpatient procedure called egg retrieval.
  • Having an embryo placed directly into your uterus with a pipette during a procedure called embryo transfer.

Since menstruation stops during pregnancy, many people experience relief from pain and other endometriosis symptoms during this time. Once you deliver, your symptoms may return.

How to treat endometriosis naturally

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You may be able to reduce the pain of endometriosis through alternative therapies. Ask a doctor about any natural remedies youre considering. In some instances, they may be compatible with medical treatments youre already having. In other instances, they may conflict.

Natural remedies for endometriosis may include:

  • Acupuncture. A review of studies indicates that acupuncture may reduce the pain caused by endometriosis. Although more research is needed, studies also indicate that acupuncture improves IVF outcomes.
  • Anti-inflammatory diet. Since endometriosis causes inflammation, avoiding foods like red meat and adhering to an anti-inflammatory diet may be beneficial.
  • Massage. A type of massage therapy called osteopathic manipulative therapy may help relax the pelvic muscles and reduce pain. It may also be beneficial for reducing inflammation.
Treating endometriosis at home

Home remedies may reduce your discomfort. Examples include:

  • NSAIDs. Nonsteroidal anti-inflammatory drugs like ibuprofen (Advil/Motrin) can reduce pain and swelling.
  • Exercise. Exercising regularly has many benefits, including alleviating stress, supporting pain management, and reducing inflammation.
  • Heat. Try placing a hot water bottle or heating pad on your abdomen.
  • Meditation. Meditation helps reduce stress and improve pain management.
  • Tea. Drinking teas that have anti-inflammatory properties, such as ginger and turmeric, may help.

Advocating for yourself

You dont have to live with endometriosis pain. Have an open dialogue with a doctor you trust about your quality of life and what youre going through. When people feel too embarrassed or awkward to discuss certain symptoms with their doctors, they dont get the treatment they need.

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Keep in mind, historically, doctors have not done a great job handling womens pain. If your doctor isnt taking your symptoms or concerns seriously, find an empathetic gynecologist who will. The American College of Obstetricians and Gynecologists has a great directory.

Takeaway

Endometriosis is a chronic condition that can cause pain and infertility.

Treatments for this condition center on symptom relief. Hormonal medications are often enough to reduce the pain and heavy menstrual bleeding caused by endometriosis. Pregnancy can often be achieved naturally or through assisted reproductive technologies such as IVF.

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