If you’ve recently been diagnosed with endometriosis, you’re likely going through a whirlwind of different emotions, and that’s okay. You may be feeling anxious and at the same time, relieved. Now you know why you’ve been dealing with symptoms like severe cramping, discomfort during intercourse, painful urination or infertility. But you might also be wondering: What happens now?
While endometriosis is a chronic condition, there are a range of treatment options to help effectively manage your symptoms and dramatically improve your quality of life. This starts by working with your doctor to create an endometriosis treatment plan that works best for your unique symptoms and preferences.
Treatment options can range from pain management to hormone therapy to surgery, and they’re working for millions of people living with the condition. Here’s what you need to know about endometriosis treatment options and how they can help you manage your symptoms.
What’s the best treatment option for endometriosis? It depends on a few factors.
Every person’s treatment plan will be unique. And while multiple factors will be taken into account as you and your doctor discuss your options, there are three key considerations that will guide your doctor’s recommendations.
What your pregnancy goals are
Endometriosis is often linked to difficulty conceiving, and women with endometriosis may experience infertility. So some of the first questions your doctor will ask when figuring out your treatment plan will be about your pregnancy goals:
- Are you actively trying to get pregnant?
- Do you hope to conceive children in the future?
- How soon in the future do you wish to become pregnant?
Why is this all so important? Endometriosis tissue growth appears to be affected by hormones, and your hormone levels are directly related to your fertility. It’s not uncommon for doctors to recommend hormone therapy and possibly surgery, but some treatments can affect fertility. So your doctor will use your pregnancy goals to give you the best possible care and create a personalized treatment plan.
The severity of your endometriosis symptoms
Getting diagnosed with endometriosis might have been a lengthy process for you that involved some kind of diagnostic imaging test, like an ultrasound. While these are helpful tools, a laparoscopy – a minimally invasive surgical technique – is the only way doctors can confirm endometriosis and determine how advanced it is. During this procedure, doctors make small incisions in the abdomen to see the endometrial growths and possibly remove them.
Treatment options may depend on the severity of your endometriosis. Your doctor can determine this by noticing whether the growths are isolated or clustered, how deep into the tissue the growths exist, and whether scar tissue is present. For example, the most severe case of endometriosis includes large cysts on the ovaries and adhesions that cause organs to stick together, causing sharp pains.
Understanding the severity can help your doctor determine how advanced the endometrial tissue growth is and if more aggressive treatment options should be considered.
Your age
Endometriosis most commonly affects reproductive-age women. When someone goes through menopause, estrogen hormones levels drop and ovulation ends – menopausal women with a history of endometriosis will typically experience symptom relief because of these changes. So, your age and how close you may be to menopause are often key considerations in developing your endometriosis treatment plan.
Endometriosis treatment: Pain management
The first step in treating endometriosis is often pain management. Your doctor may recommend over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to help with inflammation and cramping.
Managing painful symptoms is an important step, whether or not you’re hoping to get pregnant. Your pregnancy goals, however, will determine what treatment your doctor recommends next.
Endometriosis treatment if you’re hoping to get pregnant
If you’re trying to become pregnant or hope to conceive in the future, endometriosis-related lesions, cysts and scarring can make it more difficult. But there are techniques that can ease your endometriosis symptoms and increase your chances of getting pregnant.
Laparoscopic surgery to remove excess endometrial tissue (and help increase your chances of getting pregnant)
Since the buildup of scar tissue in the uterus from endometriosis may lead to fertility issues, laparoscopy – which is typically used to diagnose endometriosis – can be used to remove lesions and scar tissue. This will not only help increase your chances of getting pregnant, but it will also help protect your uterus and ovaries.
During the procedure, your doctor will make small incisions in your abdomen and then insert a slim instrument (laparoscope) to see and remove the endometrial growths. The goal of this type of endometriosis treatment is to remove endometrial growths without harming the healthy tissue around it. This surgery can also provide pain relief.
Endometriosis treatment if pregnancy is not a goal
If you’re not planning to get pregnant in the future, there are other treatment options available to you. In addition to pain management, other more conservative management methods may be recommended before you consider surgical endometriosis treatment options.
Hormone therapy for endometriosis
Hormone therapy is an effective treatment option that can help manage your pain and symptoms in two ways: It can change your hormone levels or stop your body from producing certain ones altogether. Although doctors don’t know exactly what causes endometriosis, its symptoms are affected by your body’s hormones.
Hormone therapy can affect your ability to get pregnant, which is why this treatment option isn’t recommended for everyone.
Combination birth control: Pills, patches or rings
Hormonal contraceptives like combination birth control pills, patches or rings, can help with endometriosis symptoms because they can make your period shorter, lighter and more regular.
Combination birth control has two hormones – estrogen and progestin – that can help manage endometriosis symptoms by controlling the timing of your menstrual cycle and the severity of related symptoms.
Combination birth control is used in 28-day cycles. For 21 days, birth control hormones help prevent pregnancy and menstruation. During the other seven days (the hormone-free week), your body is triggered to go through menstruation for a controlled amount of time. This minimizes the chances of a long, irregular period, which can make your symptoms worse.
Your doctor might also prescribe using hormonal contraceptives and skipping the hormone-free week, which may cause your period to stop completely, helping to further suppress endometriosis symptoms.
Progestin therapy
Progestin therapy is a treatment option where progestin – a synthetic lab hormone meant to mimic progesterone – is administered in one of four ways: a daily pill, the placement of a hormonal IUD, regular progestin injections or a Nexplanon implant.
Progestin helps prevent pregnancy, and it can also stop your period and prevent endometrial tissue growth, helping to minimize your symptoms. When progestin therapy is administered as a pill, it’s taken daily. Hormonal IUDs are inserted into the uterus and prevent pregnancy by releasing small amounts of progestin. It can potentially stop eggs from leaving your ovaries and makes it harder for sperm to get through by making your cervical mucus thicker. Progestin injections are taken once every three months and usually stop menstruation.
GnRH agonists and antagonists
Gonadotropin-releasing hormone (GnRH) medicines are a treatment option that makes the body imitate menopause and its symptoms. This means you may experience common menopause symptoms like hot flashes and mood changes but the decrease in hormone production can limit new tissue growth that causes your painful and annoying endometriosis symptoms. How?
GnRH medicines stop the body from producing hormones that make it go through ovulation and menstruation – symptom triggers for people with endometriosis. The antagonists work against ovarian hormones by limiting the production of these hormones, while agonists stop them completely.
GnRH medicines come in pills or as an injection, and are often recommended for about six months at a time. These medicines aren’t long-term treatments and won’t be continued forever. If this treatment is to be repeated, your doctor will likely schedule several months between treatments because there is an increased risk for bone loss.
Aromatase inhibitors
Aromatase inhibitors reduce the amount of estrogen in the body. While they don’t stop the ovaries from making estrogen, they stop aromatase – an enzyme found in fat tissue – from changing other hormones into estrogen and promoting endometrial tissue growth. Aromatase inhibitors may be built into your treatment plan alongside other hormone therapy options.
Surgery for endometriosis
If more conservative treatment options are not effective or your endometriosis becomes more advanced, your doctor may recommend a surgical option: a hysterectomy.
During this procedure, your uterus will be removed, which can provide relief for painful cramping and heavy bleeding. And it also prevents you from getting pregnant in the future. Your doctor will determine whether to also remove your ovaries during the procedure – a decision that comes down to a few different factors.
Hysterectomy (without the removal of the ovaries)
Your doctor may recommend a hysterectomy without removal of your ovaries to preserve the low levels of estrogen that your ovaries produce – and prevent you from entering menopause early. If you are premenopausal and not at risk for ovarian cancer, you doctor may recommend an ovary-sparing hysterectomy to prevent other possible health complications later in life.
Hysterectomy (with the removal of the ovaries)
Your doctor may recommend a hysterectomy with the removal of your ovaries (oophorectomy). By removing the ovaries, your body will stop releasing the ovarian hormones that make you ovulate and get your period. It’ll also lower estrogen levels, which can slow and stop endometrial tissue from growing.
Removing your ovaries can be highly effective in treating endometriosis, but it does come with side effects and long-term health risks. An oophorectomy puts your body into menopause, meaning you’ll likely begin experiencing a range of menopause-related symptoms. Additionally, the long-term effects of early ovary removal – before your body reaches natural menopause – include an increased risk of parkinsonism, cognitive impairment or dementia, depression and anxiety.
Relief from endometriosis is possible
Once you have an endometriosis diagnosis, it puts you one step closer to treatment – and saying goodbye to painful cramps and periods. It may also improve your chances of getting pregnant after months or years of trying.
If your symptoms are mild, your primary care doctor or OB-GYN can guide you through a more conservative treatment plan. But if certain hormonal therapies or surgical treatments may be needed, an OB-GYN can provide that more advanced care.
Whether you’re looking for relief from your symptoms or hoping to become pregnant, endometriosis doesn’t have to stop you from living the life you want.