Endometriosis Treatments

Are there treatments for endometriosis?

There are a number of treatments for both pain and infertility related to endometriosis.

First, let's focus on the treatments for endometriosis pain. They include:

Pain medication

Works well if your pain or other symptoms are mild. These medications range from over-the-counter remedies to strong prescription drugs.

Hormone Therapy

Is effective if your areas are small and/or you have minimal pain. Hormones can come in pill form, by shot or injection, or in a nasal spray. Common hormones used to treat endometriosis pain are progesterone, birth control pills, danocrine, and gonadatropin-releasing hormone (GnRH).

Surgical treatment

Is usually the best choice if your endometriosis is extensive, or if you have more severe pain. Surgical treatments range from minor to major surgical procedures. Go to the What are the surgical treatments for endometriosis pain? section for more information about these options.

I have been a patient of Dr. Shashoua's for the last several months. I am 33 years and have been suffering from endometriosis and adenomysis since the age of 16. I sought treatment from Dr. Shashoua due to the constant, severe pelvic pain steming from the endometriosis and adenomysis. Prior to seeking Dr. Shashoua's help I had four laparoscopies, excising the endometriosis. Each time it grew back faster and became more painful. I have been on either the pill, the shot, lupron and/or pain meds for the last 15+ years trying to control the pain. Nothing worked. Dr. Shashoua recommended three things. First, another laparascopy to remove the endometrisis. Second, a presacral neurectomy which would remove the nerves to my uterus and finally, the mirena IUD to slow the growth of the endometriosis. At first I was hesitant to agree to the presacral neurectomy, concerned about loss of sensation or other possible side effects. However, I felt like I was out of options. I could not deal with the daily pain any longer. I had the surgery in August of this year. It has been the best decision I have ever made. I wish that I would have met Dr. Shashoua sooner. I am now PAIN FREE and have not experienced any lasting side effects. It is absolutely amazing. Thank you Dr. Shashoua. You have changed my life.                                                                                         AF, Chicago

What are the hormone treatments for endometriosis pain?

Because hormones cause endometriosis to go through a cycle similar to the menstrual cycle, hormones can also be effective in treating the symptoms of endometriosis. In fact, if a woman's symptoms do not respond to hormone therapy, health care providers may go over their diagnosis of endometriosis again, to make sure she really has the condition.

Health care providers may suggest one of the following hormone treatments:


Oral contraceptives or birth control pills

Regulate the growth of the tissue that lines the uterus and often decrease the amount of menstrual flow. In general, the therapy contains two hormones, estrogen and progestin.

  • It often works as long as you take the pills. Once you stop the treatment, your ability to get pregnant returns, and your symptoms of endometriosis may also return. Many women continue the treatment indefinitely.
  • Some women take birth control pills continuously, without using the sugar pills that signal the body to go through menstruation. When birth control pills are taken in this way, the menstrual period may stop altogether, which can reduce pain or get rid of it entirely.
  • Some birth control pills contain only progestin, a progesterone-like hormone. Women who can't take estrogen use these pills to reduce menstrual flow.
  • Some women may not have pain for several years after stopping treatment.
  • You may have some mild side effects from these hormones, such as weight gain, bleeding between periods, and bloating.

Progesterone and progestin

Improve symptoms by reducing a woman's period or stopping it completely.

  • As a pill taken daily, these hormones will reduce menstrual flow without causing the lining of the uterus to grow. As soon as you stop taking the pill form, you can get pregnant and your symptoms may return.
  • As an injection taken every three months, these hormones will usually stop menstrual flow. It may take a few months for your period to return after you stop taking the injections. When your period returns, so does your ability to get pregnant.
  • You may gain weight or feel depressed while taking these hormones.

Danocrin

Stops the release of hormones that are involved in the menstrual cycle.

  • You will probably get your period only now and then while taking this drug; or, you may not get it at all.
  • You should take steps to prevent pregnancy while you are on this medication because danocrine can harm a baby growing in the uterus. Because you should avoid taking other hormones, like birth control pills, while on danocrine, health care providers recommend that you use condoms, a diaphragm, or other "barrier" methods to prevent pregnancy.
  • Common side effects include oily skin, pimples or acne, weight gain, muscle cramps, tiredness, smaller breasts, and breast tenderness.
  • You may also have headaches, dizziness, weakness, hot flashes, or a deepening of your voice while on this treatment.


Gonadatropin-Releasing Hormone (GnRH) Agonists

Block the production of certain hormones to prevent menstruation, which slows or stops the growth of endometriosis, sending the body into a "menopausal" state.

  • GnRH agonist is used daily in a nose spray, or as an injection given once a month or every three months.
  • Most health care providers recommend that you stay on the GnRH agonist for about six months. After that time, your body will come out of the menopausal state. You'll start having your period again and could get pregnant.
  • After women stop taking GnRH agonists for six months, about 50 percent have some return of their endometriosis symptoms.
  • These medications also have side effects, including hot flashes, tiredness, problems sleeping, headaches, depression, bone loss, and vaginal dryness.


Current research is exploring the use of other hormones in treating endometriosis and pain related to endometriosis. Some of these include GnRH antagonists, selective progesterone receptor modifiers, and selective estrogen receptor modulators, also known as SERMs. For more information about these hormones, talk to your health care provider.

Some women also have less pain from endometriosis after pregnancy, but the reason for this is unclear. Researchers are trying to determine whether it is because the hormones released by the body during pregnancy also lessen the growth of endometriosis, or if pregnancy causes changes in the uterus or endometrium that lessen the growth of endometriosis.

What are the surgical treatments for endometriosis pain?

If you have severe pain from endometriosis, your health care provider may suggest surgery. At surgery, your health care provider can locate any endometriosis and see the size and degree of growth; he or she may also remove the endometriosis at that time.

You and your health care provider should talk about possible options for removing endometriosis before your surgery. Then, based on the findings and treatment at surgery, you and your health care provider can discuss medical treatment options for after surgery.

Health care providers may suggest one of the following surgical treatments:


Laparoscopy

A way to diagnose and treat endometriosis without making large cuts in the abdomen.

  • Laparoscopy involves a small cut in the abdomen, inflating the abdomen with a harmless gas, and then passing a viewing instrument with a light (called a laparoscope) into the abdomen. The surgeon uses the laparoscope to see the growths.
  • To treat the endometriosis, the doctor can then remove the areas, a process called excising (pronounced eks-size-ing), or destroy them with intense heat and seal the blood vessels without stitches, a process called cauterizing (pronounced kaw-terr-eyes-ing), or vaporizing. The goal is to treat the endometriosis without harming the healthy tissue around it.
  • If your surgeon is going to treat the endometriosis during your laparoscopy, he or she must make at least two more cuts in your lower abdomen, to pass lasers or other small surgical instruments into your abdomen to remove or vaporize the tissue.
  • Doctors don't know the exact role of scar tissue in causing endometriosis pain, but some will remove the scar tissue in case it is causing the pain.

Usually, laparoscopy does not require an overnight stay in the hospital. Recovery from laparoscopy is much faster than for major surgery, like laparotomy, a procedure described below.

Major abdominal surgery, or laparotomy

A more involved surgical procedure, which requires longer recovery time (often one-to-two months).

  • During laparotomy, doctors either remove the endometriosis and/or remove the uterus (a process called hysterectomy).
  • Doctors may also remove the ovaries and fallopian tubes at the time of a hysterectomy, if the ovaries have endometriosis on them, or if damage is severe. This process is called total hysterectomy and bilateral salpingo-oophorectomy (pronounced bye-latt-ur-el sal-ping-go ooh-for-ek-toe-mee).
  • Health care providers recommend major surgery as a last resort for endometriosis treatment. Having the surgery does not guarantee that the endometriosis will not return or that the pain will go away.

 

If a woman's pain is extreme, doctors may recommend more drastic procedures that cut the nerves in the pelvis to lessen the pain. One such procedure can be done during either laparoscopy or laparotomy. Another procedure, called a laparoscopic uterine nerve ablation (LUNA) is done during a laparoscopy. Because these procedures cannot be reversed, you and your health care provider will need to talk about these options in great detail before making the final decision about treatment.

What are the treatments for infertility related to endometriosis?

In vitro fertilization (IVF) procedures are effective in improving fertility in many women with endometriosis. IVF makes it possible to combine sperm and eggs in a laboratory and then place the resulting embryos into the woman's uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis.

In the early stages of IVF, a woman takes hormones to cause "superovulation," which triggers her body to produce many eggs at one time. Once mature, the eggs are collected from the woman, using a probe inserted into the vagina and guided by ultrasound. The collected eggs are placed in a dish for fertilization with a man's sperm. The fertilized cells are then placed in an incubator, a machine that keeps them warm and allows them to develop into embryos. After three-to-five days, the embryos are transferred to the woman's uterus. It takes about two weeks to know if the process is successful.

Even though the use of hormones in IVF is successful in treating infertility related to endometriosis, other forms of hormone therapy are not as successful. For instance, hormone therapy that prevents a woman from getting her period, or from ovulating each month, does not seem to improve infertility related to endometriosis. But, researchers are still looking into hormone treatments for infertility due to endometriosis.

Laparoscopy to remove or vaporize the growths in women who have mild or minimal endometriosis is also effective in improving fertility. Some studies show that surgery can double the pregnancy rate.