The answer to this question depends on several factors, but the most important is to identify the stage of your endometriosis diagnosis, in order to choose the most appropriate method of treatment.
Treatment methods For Endometriosis
There is no current cure for Endometriosis, but there are two main treatment options:
- Pain management
- Fertility improvement
Before determining which method is best for you, healthcare providers consider the following factors:
- Severity of symptoms
- Stage of disease
- Family planning
It is important to note that not all treatment methods are effective for all women and the symptoms of Endometriosis can return once treatment methods are stopped.
Pain management treatment
- Hormone therapy
- Pain medication
Hormones influence Endometriosis intervals and can mimic a cycle similar to the menstrual cycle; they can then be effective in treating Endometriosis-associated pain. Hormones can be administered in pill, injection, or nasal spray form.
Hormone treatment stops the ovaries from producing hormones, including estrogen, and usually prevents ovulation. This helps to slow the growth and local activity of both the endometrium and its lesions.
Healthcare providers may suggest one of the following hormone treatments to help reduce Endometriosis-related pain.
Gonadotropin-releasing hormone (GnRH)
GnRH medicines stop the production of certain hormones to prevent ovulation, menstruation, and Endometriosis growth. The body is in the ‘’menopausal” state while under this treatment. GnRH medicines (Elagolix; Orilissa) stop hormone release in order to prevent Endometriosis development. It is the first pill approved by the U.S. Food and Drug Administration (FDA) to treat the pain associated with Endometriosis.
What should you know about this medicine?
- Low-dose pills should not be taken for more than 24 months / high- dose pills should not be taken for more than 6 months as it may cause bone density loss
Common side effects include headache, nausea, sleeping difficulties, absence of periods, anxiety, depression, and joint pain
Oral contraceptives, or birth control pills, can make a woman’s period lighter, shorter and regular, and are also prescribed to reduce the pain derived from Endometriosis. In general, this therapy contains two hormones: estrogen and progestin (a progesterone-like hormone). Women with cardiovascular problems, or who are under a high risk of blood clots, should only use progestin and not estrogen.
Typically, women take contraceptive pills for 21 days, followed by sugar pills for 7 days, to mimic the natural menstrual cycle. Some women benefit by taking these pills continuously, without the sugar pills which signal the body to menstruate. These hormones can have some mild side effects, such as weight gain, bloating, and bleeding between periods, especially when a woman starts treatment for the first time.
Pain medication may work well if pain or other symptoms are mild. These medications range from over-the-counter to stronger prescription pain
relievers. The most common types of pain relievers are non-steroidal anti- inflammatory drugs, also called NSAIDS. The evidence on the effectiveness of these medications for relieving Endometriosis-associated pain is limited.
Research shows that certain surgical treatments can provide significant, albeit short-term, relief from Endometriosis-related pain. A surgeon can locate the specific area of Endometriosis, assess the size and degree of growth and remove it.
It is important to discuss your surgery plan as certain procedures cannot be reversed, and can affect fertility. All available options should be examined with your healthcare provider before making a final decision regarding treatment.
Your surgical team may suggest one of the following treatments to resolve Endometriosis derived pain:
A surgical instrument is inserted to gently inflate the abdomen with gas in order to view the abdomen with a ‘laparoscope’ through a small incision so as to assess any visible growths.
To remove the Endometriosis, a surgeon will make at few more incisions in the abdomen and insert a laser to remove any lesions; this process is called ‘excising’. Lesions can be destroyed with intense heat, sealing the blood vessels without stitches. This process is called ‘cauterizing’ or ‘vaporizing’.
Some surgeons may also remove scar tissue at this time, as it can contribute to Endometriosis-associated pain. The goal is to treat the Endometriosis without harming the healthy tissue around it. With surgery, most women have pain relief for a short period of time, but this derived pain often returns. Some studies have shown that surgical treatment for Endometriosis-related pain is more effective in women who have moderate Endometriosis, rather than mild.
This major surgical procedure, involves the removal of Endometriosis growths, which can lead to the removal of the uterus or a hysterectomy. If the ovaries are affected by Endometriosis, or if the damage is severe, the surgeon may remove the ovaries and fallopian tubes along with the uterus. This process is called a ‘complete hysterectomy’ and ‘bilateral salpingo-oophorectomy’. Having a hysterectomy or salpingo-oophorectomy does not guarantee that the lesions will not return or that pain will be fully eliminated.
Pelvic Nerve Severance
If pain is located in the center of the abdomen, healthcare providers may recommend severing the nerves in the pelvis to lessen the pain. This can be done during either a laparoscopy or laparotomy. Two procedures are used to sever different nerve locations in the pelvis:
1. A presacral neurectomy severs the nerves connected to the uterus.
2. A laparoscopic uterine nerve ablation (LUNA) severs nerves in the
ligaments that secure the uterus.
In some cases, hormone therapy is also utilized before or after surgery to reduce pain and continue with treatment.
Infertility Treatment Methods
If pregnancy does not occur after laparoscopic or surgical treatment, in vitro fertilization (IVF) may be the best option to treat infertility caused by Endometriosis.
IVF makes it possible to combine sperm and eggs in a laboratory to create an embryo. The resulting embryo is then placed into the woman’s uterus. IVF is one type of assisted reproductive technology that may be a successful option for women affected by infertility-related Endometriosis.
For more information on IVF preparation and processes, see our Be Parent article
Hormonal Indications For Starting IVF.