What are the treatment options?
Currently there is no cure for endometriosis but a range of treatments are available to help manage the symptoms and reduce the impact of the disease on a person’s life.
Endometriosis treatments fall into three categories – painkillers, hormonal treatments and surgery. Many people find relief through medicine and pain management alone and may not need, or not want, to undergo surgery if their symptoms are controlled. The treatments received will depend on the severity of a person’s symptoms, their personal circumstances and preferences, and any other physical or mental health conditions they may have.
Most people will be offered some kind of pain relief when they first go to a GP with symptoms. This might be something that acts on pain nerves (such as paracetamol) or that reduce inflammation (such as ibuprofen). There are also medicines available that help reduce heavy bleeding, if this is one of the main symptoms.
Sometimes low doses of antidepressants or anti-anxiety medicines are given to people experiencing chronic pain. If someone is prescribed an antidepressant drug for their endometriosis symptoms it does not mean that their doctor thinks they are are depressed or that their symptoms are all in their head. Neuromodulators are most often prescribed as antidepressant medication but in low doses can be used to treat certain types of nerve pain.
Hormonal medicines and devices
A doctor may offer medicine that acts on hormone levels to slow the growth of endometriosis. This is intended to keep hormone levels stable, avoiding the fluctuations that typically take place with the menstrual cycle. Endometriosis seems to be aggravated when exposed to the hormone oestrogen in particular. Many hormone treatments are designed to directly reduce the amount of oestrogen in the body. This in turn can reduce symptoms and suppress disease activity.
Hormonal medicine can slow the worsening of endometriosis disease but it will not stop it entirely or cure disease that already exists. This means that hormones cannot cure problems that endometriosis has already caused or can cause in the future by the disease worsening over time (e.g., infertility).
Some people find that medicine alone does not control their symptoms or that the medicine becomes less effective over time. Some people also find the side effects of hormonal treatments too difficult to manage or that the relief they get is not enough to justify the side effects. In these cases surgery might be considered to treat the disease.