For Your Patients: What to Know About Endometriosis Treatment

You may have been diagnosed with endometriosis based on your symptoms, a pelvic exam, and/or imaging such as ultrasound. The next step is treatment, which is usually based on the severity of pain and your desire for pregnancy. Doctors have a range of options for treating and managing endometriosis, and can also discuss certain lifestyle changes and mind-body exercises.

Pharmaceutical Treatment

Your doctor may initially suggest over-the-counter agents to reduce the painful inflammation and the size of lesions -- for example, ibuprofen (Advil, Motrin) and naproxen (Aleve). There are also stronger pharmaceutical-grade anti-inflammatories such as celecoxib (Celebrex).

These all belong to the widely used medication class called non-steroidal anti-inflammatory drugs (NSAIDs). If you are not intending to get pregnant, the next step would likely be oral contraceptives to suppress ovulation and provide extra progesterone so as to reduce estrogen's actions on causing pain and growth of endometriosis.

If after a few months oral contraceptives are not effective, your doctor may prescribe a different type of hormonal therapy that more specifically targets estradiol production, such as gonadotropin-releasing hormone (GnRH) analogues such as leuprolide (Lupron), a GnRH agonist, or elagolix (Orilissa), a GnRH antagonist.

Both agents act on the pituitary gland to suppress the hormones that act on the ovary to produce estrogen.

Both classes of these medications result in varying degrees of a menopausal-like state; this can be minimized, however, with the addition of "add-back" therapy (most commonly a progestin-based pill called norethindrone acetate).

Surgery

If medical treatment doesn't help, surgery may be required to remove the lesions of endometriosis.

Surgery is usually performed laparoscopically under general anesthesia using a thin tube with a small camera inserted into the abdomen through a small opening.

Surgery can involve a process called ablation, in which lesions and scar tissue are reduced by "burning off" the tips with an energy source such as a laser or electrocautery. Surgical excision can also be used to remove lesions below the surface. Your provider will let you know which approach (or if a combination approach) will be used.

Since pain can return within several months of surgery, postoperative medical therapy is recommended, as studies have suggested that combining surgery with medical therapy is the most effective approach.

Lifestyle Changes

For some women with endometriosis, exercise, better sleep and rest patterns, or mind-body approaches can help.

Mind-body approaches include relaxation techniques, yoga, meditation, biofeedback, and group or one-on-one cognitive behavioral therapy. These have been shown to ease the chronic pain, fatigue, stress, anxiety, and depressive symptoms of endometriosis.

On the dietary front, foods high in fiber and the anti-inflammatory omega-3 fatty acids found in cold-water fatty fish, avocados, and walnuts may help. Ask your doctor if supplements are in order.

Some women with endometriosis may also get some relief by avoiding certain "pro-inflammatory" foods such as gluten, fatty meats, caffeine, alcohol, sugary drinks, and processed foods.

In addition, a diet low in fermentable carbohydrates known as FODMAPs (which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) of the type used to ease irritable bowel syndrome has shown benefit in some studies.

In summary, an overall healthy diet and good exercise, sleep, and rest practices should be part of your plan to tame endometriosis.

Read previous installments in this series:

Part 1: What Is Endometriosis?

Part 2: How Will Your Doctor Diagnose Endometriosis?

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.