A main symptom of endometriosis is chronic pain. The pain tends to be especially strong during ovulation and menstruation.
Symptoms can include severe cramping, pain during sex, very tight pelvic floor muscles, and discomfort with bowel movements and urination, among others. These symptoms can interfere with everyday life, too.
There’s no cure for endometriosis, but treatments can help. The effectiveness of different treatments varies from person to person. The goal is to stop or improve the pain of the condition. Read on to learn more about specific treatment options that may help.
Both prescription and over-the-counter pain relief medications can be an option for endometriosis. For moderate to severe endometriosis, many women find that over-the-counter pain relievers aren’t strong enough to address the pain. You can talk to your doctor about the best choice for you, based on your symptoms.
The most common pain medications for endometriosis are nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDS include ibuprofen, aspirin, and naproxen. Prescription NSAIDs are available, as well.
NSAIDs work on endometriosis pain by blocking the development of prostaglandins, a type of biological compound produced in your body. Prostaglandins cause the pain, swelling, and inflammation many women with endometriosis experience during their periods.
The catch? In order for NSAIDs to be most effective, they have to be taken before the body starts producing these pain-causing compounds.
If you’re taking NSAIDs for endometriosis, try to start taking them at least 24 to 48 hours before you start ovulating and before the first day of your period. This will give the medication time to block the development of prostaglandins in your body. If your period is irregular or a bit unpredictable, your doctor may suggest taking pain medication for the entire week leading up to your period.
The same medications don’t work for everyone. Your doctor may recommend you try different NSAIDs — or a combination of NSAIDs and other therapies — to get relief. Some NSAIDs shouldn’t be combined with other drugs. Be sure to talk to your doctor before starting any new medication.
Hormone therapy treats the pain of endometriosis by controlling hormonal spikes during your menstrual cycle. It may reduce or stop menstruation altogether. It’s generally not an option if you’re trying to become pregnant.
The hormones that your body releases around ovulation and your period usually cause endometriosis symptoms to worsen. This can lead to scarring in the pelvis or make existing scarring thicken. The goal of hormone therapy is to prevent new or additional scarring by keeping your hormones level.
Types of hormonal therapy for endometriosis include:
Hormonal birth control
Combination birth control pills have been used to treat endometriosis since the 1950s. They’re considered a mainstay of treatment. Other forms of birth control, like the hormonal IUD, vaginal rings, or patches, are often prescribed, too.
If you opt for an oral contraceptive, your doctor may recommend taking the pill continuously. This means that you’ll avoid having a period entirely, along with the pain that goes with it. It’s safe to skip your period for several months (or even years).
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
Gn-RH essentially puts the body into artificial menopause. It reduces estrogen levels and stops ovulation and menstruation. This, in turn, can help thin endometrial scarring.
Although they’re effective, Gn-RH agonists and antagonists can have serious menopausal side effects, like loss of bone density, vaginal dryness, and hot flashes, among others. These medications are available by injection, nasal spray, and daily pill.
It’s believed that progestins reduce the symptoms of endometriosis by slowing endometrial scarring. Your gynecologist may recommend a progestin IUD, injection, or pill to better manage your symptoms.
Hormonal therapies can be extremely effective in reducing endometriosis symptoms and pain. But it’s important to remember that your symptoms may return if you stop your hormonal therapy at any time.
Surgery for endometriosis treats the condition by removing the endometrial lesions that are a source of pain. There are several types of surgery that may be used. The Endometriosis Foundation of America takes the view that laparoscopic excision surgery is the gold standard for endometriosis surgical treatment.
Laparoscopic excision surgery is often described as “conservative.” This means that the goal is to preserve healthy tissue, while removing endometrial lesions.
A 2016 review in the journal Women’s Health notes that surgery can be effective at reducing the pain of endometriosis. A 2018 study in BMJ reported that laparoscopic excision surgery effectively treated pelvic pain and bowel-related symptoms. The surgery also improved the overall quality of life for women living with endometriosis. The BMJ study included more than 4,000 participants across several different medical centers.
More invasive surgeries were more common in the past. Hysterectomy and oophorectomy, which remove the uterus and ovaries, used to be considered the best therapies for endometriosis. In general, these are no longer recommended for most people. Even if the uterus and ovaries are removed, it’s possible for endometrial lesions to occur on other organs.
Keep in mind that undergoing surgery isn’t a guarantee of long-term relief. Endometrial lesions, and the pain they cause, may recur after the procedure.
Finding the right treatment for endometriosis pain can be trial and error. You can also try alternative and homeopathic remedies in combination with your medical therapy. Always talk to your doctor before trying a new therapy of any kind.
Some alternative therapies for endometriosis include:
- Acupuncture. Research on the use of acupuncture for treating endometriosis is limited. A 2017 of existing studies suggests that acupuncture can help with endometriosis pain relief.
- Transcutaneous electrical nerve stimulation (TENS) machines. TENS devices emit a low-level electrical current that reduces pain and relaxes muscles. One small study found that TENS machines were highly effective in reducing pain, even when self-administered.
- Heat. Heating pads and warm baths may relax tight muscles and reduce pain related to endometriosis.
- Stress relief. Stress is linked to chronic inflammation and may also impact your hormone levels. Stress management techniques, such as meditation, yoga, coloring, and exercise, can keep your stress in check.
Endometriosis can be a painful condition. Trying different pain relief therapies, and finding what works best for you, is key to managing your symptoms. Talk to your doctor about your options, as well as any alternative treatments they recommend.