Treating endometriosis

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Endometriosis can be treated medically (with drugs or medicine) or with surgery. Sometimes both medicine and surgery are used. Some women also benefit from alternative therapies.

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Medications range from pain relief drugs (such as paracetamol and non-steroidal anti-inflammatories) to hormonal treatments that suppress ovulation and menstruation).

Surgery can be used to remove or burn the endometrioses. The most common surgery used is laparoscopy (key-hole surgery).

If the ovaries contain cysts of endometriosis these are best treated surgically as they are unlikely to disappear on their own and they can't be treated with medicine.

Treatment to improve fertility

Surgery has been shown to improve fertility for women with mild endometriosis. Treating more severe endometriosis with surgery, especially if there are cysts in the ovaries, also appears to improve fertility, although this hasn't been fully proven. Medication for endometriois has not been shown to improve fertility.

Other causes of infertility should be looked for and treated.

Treatment for pain

When pain is the main problem, the treatment aims to relieve symptoms and lessen the pain. 

  • Simple pain relievers (paracetamol, etc)
    Many women will experience some relief of symptoms with over-the-counter drugs such as paracetamol (Panadol) and non-steroidal anti-inflammatories (Ponstan, Nurofen, Naprogesic, etc).
  • Hormonal treatments (the Pill, etc)
    Hormone treatments are used to suppress the normal menstrual cycle, which in turn stops or slows endometriosis growth. The simplest way to achieve this is with the Pill. Other hormonal therapies that have been shown to be effective in reducing endometriosis-related pain, are also available. Some women will experience side effects with hormonal treatments.
  • Keyhole surgery or laparoscopy
    May be offered initially to help make the diagnosis. Some women are offered surgery because they don't want to take medicine or because medicines haven't worked. Surgery for endometriosis includes laparoscopy (key-hole surgery), which may be used to make the diagnosis and treat all visible endometriosis. This is done with laser or diathermy, which destroys the endometriosis by burning it. Alternatively the deposits of endometriosis can be cut away.
  • Hysterectomy
    In a small group of women who have severe symptoms that are not relieved by medical or other surgical treatment, more extensive surgery such as hysterectomy and removal of the ovaries may be considered.
  • Bowel surgery
    Sometimes the endometriosis affects the wall of the bowel. When this is causing significant symptoms it may be suggested that the affected piece of bowel is removed. This would require bowel surgery and is uncommon.

Alternative and complementary therapies

There are various treatments available that can either complement your medical treatment or are an alternative to medical treatment. The most popular is traditional Chinese medicine and herbal preparations. Some women experience improvement of their symptoms with these but there is no scientific evidence to support the effectiveness of Chinese medicines in reducing symptoms or improving fertility.

If you use complementary treatments it is wise to discuss their use with your doctor as they may interfere with other prescribed medications. The Pharmaceutical Benefits Scheme (PBS) does not cover the costs of alternative or complementary therapies.

Choosing not to treat endometriosis

Mild endometriosis doesn't always need treatment. You are usually offered treatment to help relieve the symptoms rather that to cure the disease itself.

If left untreated, some endometriosis will improve, but most will stay the same. Some will become more severe without treatment.

For most women with endometriosis, the symptoms will settle once they go through the menopause. Deciding whether or not to treat endometriosis is often a matter of balancing the risks of the treatment against the effect the endometriosis is having on your life.

Benefits and disadvantages of different treatments 

  Benefits Disadvantages
Doing nothing – no treatment
  • No side effects of drugs
  • No risks of surgery
  • Most symptoms continue
  • Some symptoms may get worse
Simple pain relief
(paracetamol, ibuprofen)
  • Easy to get
  • Side effects uncommon
  • Often not effective
  • Ibuprofen use has some health risks
Progesterone-like medications
  • Reduced pain
  • Irregular or no periods
  • Stops endometriosis growth in most cases
  • Some are contraceptive
  • Side effects possible – weight gain, moodiness, acne, increased hair, cramps, breast tenderness
  • Symptoms may recur when treatment is stopped
  • May not fix pain
  • Doesn't improve fertility
  • Shouldn't get pregnant while on drug
  • Not all contraceptive
Menopause-causing medications
  • No periods
  • Reduced pain
  • Stops endometriosis growth in most cases
  • Side effects – hot flushes, sweats
  • Bone thinning if used for more than six months
  • Symptoms may recur when treatment is stopped
  • Shouldn't get pregnant while on drug
  • Not a contraceptive
  • May not fix pain
The combined contraceptive pill
  • Contraceptive
  • Reduced pain
  • Can be taken to reduce or stop periods
  • Side effects – nausea, weight gain
  • Shouldn't get pregnant while on it
  • Small risk of clots in legs or lungs
  • A definite diagnosis
  • A long-term cure in up to 70 percent of women
  • No need to use medications long-term
  • Not all endometriosis can be treated this way
  • There are risks associated with surgery
  • May not cure the pain
  • Recurrent endometriosis in 30 percent of women
Hysterectomy and removal of endometriosis
  • Achieve long-term cure in over 90 percent of women
  • No need to use medications
  • No more periods
  • Risks of surgery greater than laparoscopy
  • Removes fertility
  • Some women grieve for uterus loss
  • May need HRT if ovaries removed
  • May not cure pain

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