Endometriosis Treatments and Medications

If you have painful periods every month that don't seem to go away no matter what you do, you may have endometriosis. Endometriosis is a condition that affects thousands of women every year in the United States.

What is endometriosis?

Endometriosis is a medical disorder that happens when tissue called the endometrium, which normally grows inside the uterus, grows outside the uterus in places where it shouldn't. Endometrial tissue can grow abnormally on the ovaries, fallopian tubes, bladder, and around the uterus. Endometrial tissue that grows outside the uterus can swell and bleed just like tissue inside the uterus would during a menstrual period, which can cause pain. The most common symptoms of endometriosis are:

• Menstrual cramps, often worsening over time

• Lower back pain

• Pain during or after sex

• Painful bowel movements or pain when urinating during menstruation

• Pelvic pain

• Bloating

• Diarrhea

• Nausea

• Constipation

• Spotting between menstrual periods

• Chronic tiredness

• Infertility

Treatment for endometriosis often involves a combination of medication, self-care, and sometimes surgery. There is no cure for endometriosis, but symptoms can be managed.

It’s estimated that over 11% of American women between the ages of 15 and 44 will get endometriosis, and it’s most commonly seen in women aged 25-40. Even though there’s no cure for the condition, doctors and researchers are always trying to find new and better ways to treat it. Advances in medicine like new blood tests designed to diagnose endometriosis faster are promising and could help change the way the disorder affects women.

How is endometriosis diagnosed?

The exact cause of endometriosis is unknown, but doctors think it’s caused by one or more of the following:

• Retrograde menstruation: This is when menstrual debris flows backward out of the fallopian tubes during menstruation.

• Hormonal changes: Due to the ups and downs of a natural menstrual cycle, or genetics. Having too much of the hormone estrogen is often linked to endometriosis.

• Surgery: During a C-section, hysterectomy, or other surgery to the abdominal area, endometrial tissue could be picked up and moved. Surgeries to the abdominal area can also cause painful scar tissue to develop that can contribute to endometriosis pain.

• Weakened immune systems: Due to autoimmune disorders or certain cancers.

Any woman who gets a period could potentially develop endometriosis, but it’s most commonly seen in women in their 30s and 40s. Women with a family history of endometriosis, women who’ve never had children, and women with abnormal uteruses or menstrual cycles are more likely to get the disorder.

A primary care physician may be able to diagnose endometriosis, but OB-GYNs specialize in treating it. An OB-GYN may order additional tests to help confirm a diagnosis. These can include:

• Pelvic exam

• Magnetic resonance imaging (MRI)

• Biopsy

• Ultrasound

• Computed tomography (CT) scan

Here are some questions you may be asked by a healthcare professional to help confirm a diagnosis:

• What type of symptoms have you been experiencing and for how long?

• Do you have a family history of endometriosis?

• Have you been having trouble getting pregnant?

• Are you currently taking any medications?

Endometriosis treatment options

Once you know you have endometriosis, the next step is seeking proper treatment for it. Here are the most popular treatment options for endometriosis:

• Medication: Medications used to treat endometriosis range from over-the-counter pain medications to birth control pills and hormone replacement therapy. We’ll take a more in-depth look at medications in the next section.

• Self-care: Many women find relief from their endometriosis symptoms with some simple self-care treatments. See “What is the best home remedy for endometriosis?” below for some of the most effective ways to treat endometriosis at home.

• Surgery: Doctors can remove patches of endometrial tissue that grow outside the uterus through surgery. Ovarian cysts that become large and painful and filled with old blood (endometriomas) can also be removed this way. Surgical procedures are often a last resort when self-care treatments and medications aren’t working because they’re invasive and could potentially cause further damage. While hysterectomy and oophorectomy used to be considered the most effective surgery for endometriosis, experts in the field are moving away from this approach, instead focusing on thorough and careful removal of endometriosis tissue. While sometimes necessary in certain cases, hysterectomy and oophorectomy are not first-line surgeries.

“The gold-standard for the diagnosis of endometriosis is called laparoscopy,” says Jessica Zager, doctor of pelvic health physical therapy at Brigham and Women's Hospital and AASECT sex counselor. “Laparoscopy is a minimally-invasive surgery conducted under general anesthesia. The surgeon makes multiple small incisions in the abdominopelvic cavity and inserts cameras to visualize the scar tissue formed by the misplaced endometrial cells. During this diagnostic procedure, many physicians will remove the scar tissue they find in hopes that it alleviates the patient's symptoms of endometriosis. Currently, this is the only definitive way to diagnose endometriosis.”

Endometriosis can’t be cured, but managing painful symptoms can be done with a little time and persistence. The treatment methods above can help prevent flare-ups during menstruation. Read this personal essay to learn more about what it’s like to live with endometriosis.

Endometriosis medications

There are many different categories of medications that doctors use to treat endometriosis. Here are some of the most popular.

Birth control

Oral contraceptive pills release hormones that help stop the abnormal growth of endometrial tissue outside the uterus. Here are some of the most commonly prescribed birth control medications for endometriosis:

• Lo Loestrin Fe

• LoSeasonique

• Natazia

Birth control pills, injections, and intrauterine devices (IUDs) aren’t the right treatment for women who have endometriosis who’re trying to get pregnant. Birth control pills may help endometriosis symptoms, but they’ll also prevent pregnancy. Talking with your doctor is the best way to find a medication that won’t interfere with your efforts to become pregnant.

Birth control pills can cause side effects like weight changes, nausea, mood changes, and changes in sex drive.

Gonadotropin-releasing Hormone (GnRH) agonists and antagonists

GnRH agonists work by causing the ovaries to produce less estrogen. When the body produces less estrogen, endometrial tissue shrinks and becomes less painful. Here are some of the most popular GnRH agonists for endometriosis:

• Synarel (nasal spray)

• Zoladex (monthly subcutaneous injection)

• Lupron Depot (monthly intramuscular injection)

Depending on individual symptoms and needs, your doctor may prescribe a GnRH agonist as daily or monthly injections or as a nasal spray. GnRH agonists may cause thinning of the bones, insomnia, dizziness, decreased sex drive, and vaginal dryness.

GnRH antagonists work by binding to GnRH receptors in the pituitary gland, causing a decrease in estradiol and progesterone. Orilissa (elagolix) is a daily tablet that is indicated for the management of moderate to severe endometriosis pain. Serious side effects include bone loss, suicidal thoughts/behavior, and menstrual irregularities.

Progestins

Progestins are a synthetic form of progesterone, which behave like progesterone to help stop the abnormal growth of endometrial tissue. Here are some of the most common progestins prescribed for endometriosis:

• Sharobel or Errin (“mini-pill”)

• Aygestin (norethindrone acetate)

• Provera (medroxyprogesterone acetate)

• Mirena IUD.

Progestin medications can cause acne, weight gain, bloating, and moodiness.

Over-the-counter pain medications

Over-the-counter drugs like ibuprofen and Tylenol can help with the most common symptoms of endometriosis like cramps and lower back pain. Nonsteroidal anti-inflammatory drugs like ibuprofen may cause dizziness, an upset stomach, and headaches, and they shouldn’t be taken by anyone who is allergic to aspirin.

What is the best medication for endometriosis?

There’s no one single medication that’s best for treating endometriosis. The type of medication you need will depend on your age, symptoms, medical history, and any medications you’re already taking. The best way to learn what medication is best for you is to talk with your healthcare provider. Here’s a list of some of the most commonly prescribed endometriosis medications.

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