Endometriosis is a condition that can cause severe pain, irregular and painful menstrual periods, and infertility (difficulty getting pregnant). There is currently no cure for endometriosis, but there are several treatments that may help reduce symptoms. It’s important to know that your symptoms may recur (come back) after treatment stops, and not all treatments work the same for everyone.

In this article, we'll review the treatment options for endometriosis. This can help you work with your health care provider to find the best treatment for you.

Selecting Endometriosis Treatments

There are three main categories of endometriosis treatment: hormone therapy, pain management, and surgery. Hormone therapies work by adjusting hormone levels to reduce the activity of endometriosis tissue. Hormone therapy is often paired with treatments to help with pain management. Surgical treatments can help when your pain isn’t controlled with other treatment methods.

To create a treatment plan that fits your needs, your health care provider will look at several factors, including:

• The severity of your endometriosis (how many growths you have and how deep they are)
• The severity of your symptoms
• Whether endometriosis affects your plans to become pregnant
• Your age and overall health
• Possible treatment side effects
• Your personal preferences

1. Combined Hormonal Birth Control

Combined hormonal birth control options are medications that have two different types of hormones — estrogen and progestin. This type of contraceptive is often used as a first-line treatment for endometriosis. It can help make your periods lighter and shorter, which can make them easier to manage. Combined hormonal birth control works mainly by preventing ovulation (when your ovaries release an egg) and stopping your ovaries from making certain hormones, like estrogen. These medications also prevent pregnancy while you’re taking them.

The types of combined hormonal birth control include:

• Oral contraceptives (birth control pills)
• Vaginal ring
• Birth control patch

There are many different branded and generic birth control pills on the market containing varying amounts of both hormones. Your health care provider can help you select the best one for you. It can take several months to see if this treatment helps your endometriosis symptoms.

Combined hormonal birth control can be used in a 28-day cycle to mimic a natural menstrual cycle. This involves 21 days of taking active pills, followed by seven days of placebo pills (inactive or “sugar” pills) during which you’ll have a period. It’s also possible to take the active treatment every day to avoid having a period.

Some people experience mild side effects when starting birth control pills, such as weight gain, bloating, and spotting (light bleeding between periods), especially for the first few weeks or months of taking them.

Combined hormonal birth control might not be an option if you have a higher risk of blood clots in your legs or lungs, or if you have heart disease.

2. Progestins

Progestins are hormones that prevent endometrial tissue from growing and can often stop your period. Progestins are a lab-made version of the hormone progesterone. They are sometimes used as a first-line endometriosis treatment for people who cannot or choose not to use combined birth control. Some types of progestins also prevent pregnancy while you’re using them.

Examples of progestins for endometriosis include:

• Norethindrone — A progestin-only birth control pill (often called the “minipill”) available in different brands and generic versions
• Medroxyprogesterone acetate injection (Depo-Provera) — A progestin-only birth control injection given once every three months
• Levonorgestrel-releasing intrauterine device (IUD) — A progestin-releasing device inserted into the uterus, available under several brand names including Mirena and Skyla
• Etonogestrel implant (Nexplanon) — A small, flexible device implanted under the skin that slowly releases progestin
• Progesterone (Prometrium) — A pill taken either daily or on a schedule, which can help reduce endometriosis symptoms

Possible side effects of progestins include weight gain, depression, or irregular menstrual bleeding.

3. Gonadotropin-Releasing Hormone Medicines

Gonadotropin-releasing hormone (GnRH) is a hormone that controls ovulation by triggering the production of estrogen and progestin. GnRH medications work by lowering estrogen levels. This puts the body into a temporary state similar to menopause, where menstruation stops but can resume after treatment. Lower estrogen helps slow down the growth of endometrial tissue, which can reduce endometriosis symptoms.

While taking GnRH medications, you won’t ovulate or have menstrual periods, and you cannot get pregnant. Endometriosis symptoms usually improve, and the disease typically does not progress during treatment. Menstrual periods and fertility usually return after stopping these medications.

Your health care provider may recommend a GnRH medicine if hormonal treatments haven’t helped.

There are two types of gonadotropin-releasing hormone medicines: GnRH agonists (which activate GnRH) and GnRH antagonists (which block GnRH). Examples of GnRH medications include:

• Goserelin implant (Zoladex) — A GnRH agonist that’s given as a subcutaneous (under the skin) implant every 28 days
• Leuprorelin acetate (Lupron Depot) — A GnRH agonist that’s given as an intramuscular (into the muscle) injection
• Nafarelin (Synarel) — A GnRH agonist taken as a nasal spray
• Elagolix (Orilissa) — A GnRH antagonist taken as a pill
• Relugolix, estradiol and norethindrone acetate (Myfembree) — A GnRH antagonist combined with estradiol and norethindrone taken as a pill

GnRH medications are usually prescribed for only six months at a time, as taking them for too long can increase the risk of heart problems and bone loss. Some doctors may suggest taking breaks between courses.

Common side effects of GnRH agonists and antagonists are symptoms typical of menopause, including hot flashes, fatigue, difficulty sleeping, headache, depression, joint and muscle stiffness, and vaginal dryness. Adding hormonal therapies may help manage these symptoms.

4. Androgen Treatments

Danazol (Danocrine) is an androgen — a type of sex hormone — used as hormone therapy for endometriosis. It works by blocking the release of certain hormones involved in the menstrual cycle. Danazol creates effects similar to temporary menopause, similar to other hormone therapies. This medication is taken orally (by mouth) as a pill.

While taking danazol, many people experience side effects, such as oily skin, acne, weight gain, muscle cramps, fatigue, reduced breast size, and breast tenderness. Danazol may also cause your voice to deepen and increase hair growth.

5. Pain Management

Pain is the most common symptom of endometriosis, and it can be intense. Pain medications can be taken with other endometriosis treatments, such as hormone therapy.

Your health care provider may recommend over-the-counter (OTC) pain relievers like acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) for mild to moderate pain. OTC NSAIDs include ibuprofen (e.g., Advil or Motrin) and naproxen (such as Aleve). Other NSAIDs are only available with a prescription, such as celecoxib (Celebrex) and diclofenac (including Cataflam and Zipsor).

NSAIDs work by blocking the production of chemicals that cause inflammation and blood clotting. Taken regularly at high doses, some NSAIDs can cause stomach ulcers and bleeding.

Other prescription pain medications that may help with severe endometriosis-related pain symptoms include:

• Opioid medications such as tramadol or hydrocodone/acetaminophen
• Low-dose naltrexone
• Cannabis-based treatments

Common side effects of these stronger pain medications include constipation. Opioids can be highly addictive, while cannabis-based treatments carry a lower risk of dependence but may be habit-forming for some individuals.

Some people find that complementary and alternative endometriosis treatments can provide pain relief, such as acupuncture treatments, heating pads, and transcutaneous electrical nerve stimulation (TENS). TENS is a therapy that uses mild electrical currents to help reduce pain signals and relax muscles in painful areas.

6. Surgery

Surgical treatments can help relieve moderate to severe endometriosis pain. However, pain relief is usually temporary.

A surgical procedure called a laparoscopy is commonly used to diagnose and treat endometriosis. During this procedure, your health care provider makes a small cut near your belly button to insert an instrument that allows them to view and remove endometriosis growths. Robotic-assisted surgery techniques may help reduce certain risks during laparoscopic surgery.

In more severe and extensive cases of endometriosis, a laparotomy may be necessary. This type of endometriosis surgery involves a longer abdominal incision to allow the surgeon full access to remove harder-to-reach endometriosis tissues and adhesions while preserving healthy tissue. Compared to laparoscopy, laparotomy requires a longer hospital stay and recovery time.

Another surgical option, called nerve ablation, involves removing specific nerves in the pelvis; however, it has not shown significant effectiveness in relieving endometriosis-related pain in studies.

In the most severe cases of endometriosis, a person may opt for a hysterectomy to surgically remove the uterus, possibly along with an oophorectomy to remove the ovaries. Hysterectomy may be performed via laparoscopy, with a traditional incision, or through the vagina. Removing only the uterus may not stop endometriosis symptoms, as the ovaries continue producing estrogen that can stimulate endometrial tissue growth outside the uterus.

After a hysterectomy, pregnancy is no longer possible. If the ovaries are also removed, menopause immediately starts, regardless of age. Hysterectomy, especially before the age of 35, has been shown to raise long-term risk for developing high blood pressure, obesity, and heart disease.

7. Aromatase Inhibitors

Aromatase inhibitors are a type of medicine that reduces levels of estrogen, which may help shrink endometriosis tissue and reduce pain. Doctors usually suggest aromatase inhibitors only if other treatments, like surgery or other hormone medicines, haven’t helped enough. These medications are usually taken for a short time because lowering estrogen too much can have side effects, like weaker bones. Sometimes, doctors combine aromatase inhibitors with other medicines to help lower these risks.

8. Lifestyle Habits

Adopting healthy lifestyle habits may help improve endometriosis symptoms. There is no specific diet for endometriosis. A diet low in meat and fat and high in fiber may help reduce estrogen levels. Reducing alcohol intake, getting regular exercise, and managing your stress may help you manage your endometriosis symptoms and improve overall quality of life and well-being.

Find Your Team

MyEndometriosisTeam is the social network for people with endometriosis and their loved ones. On MyEndometriosisTeam, more than 136,000 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.

What treatment options have you tried for managing endometriosis? What has or hasn’t helped? Share your thoughts and tips in the comments below or by posting to your Activities page.