Endometriosis Treatment Options

The goals of treatment

There’s no cure for endometriosis yet, but symptoms can be managed well for many people. Treatment aims to reduce pain, improve quality of life, protect fertility where that matters, and manage other symptoms such as fatigue and bowel problems. Most people use a combination of approaches.

Pain management

Over-the-counter pain relief helps some people, especially when taken early in the cycle. If it isn’t enough, talk to your GP. Long-term pain can also involve a sensitised nervous system, so pain management often goes beyond medicines. See central sensitisation.

Hormonal treatments

Endometriosis is driven by oestrogen. Hormonal treatments reduce the growth and activity of endometriosis, and often reduce or stop periods. The European guideline recommends hormonal treatment as a first option for endometriosis-related pain. Several different types exist, given as tablets, an intrauterine device, an implant or an injection. They suit different people depending on side effects, contraception needs and plans for pregnancy. Your GP or gynaecologist can talk through the options.

Surgery

Laparoscopic (keyhole) surgery can remove endometriosis and cysts and free up scar tissue. It can reduce pain and, for some people, improve fertility. Symptoms can come back over time, and repeated surgery has risks, so the decision is made carefully. See endometriosis surgery.

Other approaches that help

• Pelvic floor physiotherapy, especially when pelvic floor muscles are tight and painful, or for pain with sex
• Psychological support for pain coping, mood and the effects on relationships
• Heat and TENS for flare-ups
• Exercise, which can help with pain and mood
• Diet changes, which help some people with bowel symptoms, ideally with a dietitian’s guidance

If you want to get pregnant

Hormonal treatments usually prevent pregnancy, so plans for pregnancy change the approach. Surgery may help in some situations, and fertility treatment such as IVF is an option. Talk to your GP early, as a fertility referral may be worthwhile. See endometriosis and getting pregnant.

When to see a doctor

See a GP if your symptoms aren’t controlled, if a treatment is causing side effects, or if you’re thinking about pregnancy. Get urgent care for sudden severe pelvic pain, pain with fever or fainting, or pain when you might be pregnant.

References

1. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009.
2. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256.
3. Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839-852.
4. RANZCOG. Endometriosis Clinical Practice Guideline.
5. healthdirect. Endometriosis.