This article was medically reviewed by Andrew Horne, Professor of Gynaecology and Reproductive Sciences at Edinburgh University's MRC Centre for Reproductive Health.
What therapies exist for endometriosis?
Sadly, there is no cure for endometriosis. The therapies that currently exist are used to relieve or alleviate symptoms, and if the therapy is stopped, the symptoms usually return. Your doctor can recommend non-steroidal anti-inflammatory drugs, hormonal drugs, or surgery for your symptoms. Lifestyle and dietary changes can also help with endometriosis pain. Complementary treatments can also help you cope with your symptoms, such as physical or psychological therapy.
Non-steroidal anti-inflammatory options
Your GP may prescribe you non-steroidal anti-inflammatory drugs (NSAIDs) either to be used alone or at the same time as hormone treatments. These painkillers are first-line treatments that are commonly used by individuals with endometriosis symptoms because many are available over the counter. They work by blocking the pain signals before they reach the brain. Examples include ibuprofen, aspirin, and naproxen.
Paracetamol is not considered an NSAID but can still be used for mild pain.
Non-surgical hormonal options
The most common treatments that your doctor may recommend are typically hormone treatments. Endometriosis tissue is affected by hormones in the same way as endometrial tissue in the uterus.
Two of these hormones are oestrogen and progesterone, and they control your menstrual cycle. As they naturally fluctuate throughout the menstrual cycle, their rise and fall can aggravate symptoms or cause endometriosis flare-ups. Hormonal treatments help to regulate, slow down, or stop their production.
Certain hormonal treatments are designed to put the patient into an artificial menopause state. This is temporary, meaning that when you stop the hormone treatment, your period will return. Currently data shows that one drug is not superior to another, so if you experience unwanted side effects with one, your GP can switch you to a different drug.
All hormonal therapies can affect your ability to get pregnant, whilst you are taking them, so it is not for everyone. Hormonal therapy can take approximately 3-6 months for a noticeable change in endometriosis symptoms to occur, but if you feel like it isn’t working for you or doesn’t suit you, you can ask your doctor to prescribe a different option.
NICE guidelines state that if patients over 18 years are experiencing chronic primary pain (defined as pain that lasts over 3 months), their GP can prescribe neuromodulators after they discuss the benefits and harms. These include anti-depressants, selective serotonin inhibitors, or anticonvulsants. Neuromodulators work by treating neuropathic pain (pain caused by lesions or damage to the nervous system).
They block the pain signals sent to the brain, and are effective in 50-60% of patients who have chronic primary pain. For patients with endometriosis, there is not much clinical evidence to support using anti-depressants as the first option for pain during endometriosis. One study showed that although patients taking anti-depressants and GnRH drugs did exhibit less depressive symptoms, there was no difference in pain relief compared to patients that took only GnRH drugs. However, because patients with endometriosis often experience a reduced quality of life due to anxiety and depression related to pelvic pain, anti-depressants can be useful in their treatment plan.
The patient does not need a diagnosis of depression for this, but they should be informed how the medication can affect their quality of life, sleep, pain, and mental distress.
What surgery is done to treat endometriosis symptoms?
Pharmacological drugs and surgery are the only methods clinically proven and recommended by physicians to treat endometriosis.
- A laparoscopy, also known as keyhole surgery, is used for both diagnosis and treatment. Small cuts are made in your tummy and a tube with a camera is inserted to help the surgeon visualise the endometriotic tissue. You will be placed under general anaesthesia so you will not feel any pain during the procedure. If endometriosis lesions are present, the surgeon can remove them during the surgery. Lesions will either be cut away or removed with heat or a laser. Endometriomas (ovarian cysts) can also be removed.
- Hysterectomy (surgical removal of the uterus) does not guarantee relief from endometriosis-related symptoms and can neither be classified as a “treatment“, nor as a “cure” for endometriosis. There are situations where the uterus may also be affected by secondary causes for your pain; for example, by adenomyosis (where cells similar to the endometrium are embedded into the muscular layers of the uterus), and this condition is likely improved by hysterectomy.
Are any alternative therapies available?
The traditional medicines and surgery outlined above are considered the most effective and will likely be the treatments recommended for you by your healthcare practitioner to treat endometriosis because there is extensive research and evidence to back them up.
However, these interventions are not always the preferred choice for those living with endometriosis, who might be concerned about the potential, undesirable side effects or who want to try something they feel is more ‘natural.’ Also, hormonal therapy is not recommended for women with endometriosis who are trying to conceive.
Diet and Nutrition
Foods that contain pro-inflammatory ingredients such as saturated fats and trans fats can cause oestrogen imbalances. Limiting these is often recommended for those living with endometriosis. Consumption of a high-fat diet can also contribute to abdominal discomfort or ''endo-belly''.
Although some women prefer to outright eliminate pro-inflammatory foods that contain saturated fats and trans from their diet, it may be difficult at first. Dieticians recommend focusing on moderation and slowly over time reducing them from your diet. This may involve identifying alternatives to your favourite snacks and foods. You might even want to try an ‘Organic-Only Diet’ for 3 months to see any effects that certain food additives (pesticides, hormones, and antibiotics) have on inflammation, and whether adjusting your diet can help with your symptom management.
It is always important to replace key nutrients if you are eliminating certain foods and this can be best done in consultation with a nutritionist.
What herbs and supplements can be used to help endometriosis symptoms?
While the following herbs and supplements have been studied in laboratory settings, they have not been tested for their efficacy in clinical trials, and the potential benefits and/or harms have not been demonstrated.
It is important to note, that there is a lack of quality research and clinical trials concerning these therapies, so further studies need to be performed to make firm conclusions on whether or not these therapies are effective in managing endometriosis. However, many women prefer the natural route to help manage their pain and inflammation symptoms and report significant improvement in their mental and physical well-being.
Professor Andrew Horne cannot recommend any of the following alternative, non-pharmacological therapies for the treatment of endometriosis symptoms. Consult with your GP or gynaecologist for further information.
- Green tea
- Alpha Lipoic Acid
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