While there is no real cure for endometriosis, there are many different treatment options that can help stop disease progression and manage your symptoms.

Treatment options consider your age, the severity of your symptoms, the progression of endometriosis, medications you take for co-occurring conditions (including hormonal medications), and your family planning goals. While there are many treatment options available, you may need to try a few options to see what works best for you.

Hormonal Management

There are many hormonal management options to help manage the symptoms of endometriosis and disease progression. It is important discuss the benefits, side effects, and long-term effects of each option with your health care provider to see what might be the best option for you.

Hormone-based therapies can be used to manage endometriosis related symptoms. Most often, these medications take two to three months to see if they help relieve symptoms. Options for hormone-based therapies include:

• Combined hormonal contraception, such as the birth control pill, birth control patch, or birth control vaginal ring, is one of the most widely used treatments for endometriosis. These forms of contraception can reduce the pain caused by endometriosis, especially during your period. If you experience severe menstrual cramps, your health care provider might prescribe combined hormonal contraception continuously—without having the typical seven-day break—to prevent you from menstruating.
• Progestin therapy, such as a progestin-only birth control pill, an oral pill (e.g., Dienogest or Noresthisterone acetate), or an injection, can help lessen the effects of estrogen that stimulate endometriotic growth. Oral (non-birth control) pills prescribed to reduce endometriosis symptoms may not be effective as contraception, so a barrier method of birth control is necessary if you are taking non-birth control pills.
• An intrauterine device (IUD) may be recommended if combined hormonal contraception or progestin therapy is not effective to manage your symptoms. An IUD is a form of long-acting reversible contraception, which is a T-shaped device that releases a type of progestin that counteracts the effects of estrogen in the same way that other progestin therapies do. The IUD can provide continuous therapy for eight years or until it is removed by a health care provider. The IUD is a very effective therapy because it stops menstruation and slows down the growth of endometriosis. It is also a very effective form of contraception.
• Gonadotropin releasing hormonal (GnRH) agonists with ‘add back’ therapy, given by injection or nasal spray, will similarly cause you to stop menstruating and may relieve symptoms of endometriosis. GnRH side effects are similar to what may be experienced in menopause (loss of bone mineral density, hot flashes, mood swings, vaginal dryness, etc.).
• GnRH antagonists may also be recommended to treat painful symptoms experienced due to endometriosis. GnRH antagonists reduce the levels of estrogen in your body. Side effects may be similar to those experienced with GnRH agonists.
• Danazol was once one of the most common medical treatments for endometriosis. It is an oral medication that stops you from menstruating; however, due to its associated side effects and the introduction of other hormonal therapies, it is rarely recommended as a long-term therapy.

Surgical Management

If your endometriosis symptoms persist despite medication or other forms of treatment, surgery to remove endometriosis growth and scar tissue may be helpful. Surgery may also be recommended if your endometriosis is very extensive (involving the bowel, bladder, uterus, or nerves), if you have ovarian cystic lesions, if your diagnosis is too uncertain to proceed with treatment, or if you are experiencing infertility.

There are several techniques that can be used during surgery to remove endometriotic growths and scarring. The methods you and your health care provider choose will be based on how extensive your endometriosis is and where it is located. Ablation is the removal of tissue by scraping or burning the tissue. While this technique can be helpful in removing superficial lesions, it may not be possible to remove all the tissue. Excision is the removal of tissue by cutting the whole lesion, which is why it is often the chosen technique for deeply invasive endometriosis or endometriosis involving other organs. In some cases, a hysterectomy may be discussed. While some people may not experience any symptoms after menopause or a hysterectomy, this is not the case for everyone.

Surgery is not effective for everyone. Surgery should be performed by a gynaecologist with special training in endometriosis. While some people may see symptom improvement after surgery, endometriosis may return for others. As all surgeries have some amount of risk, surgery is not recommended for everyone with endometriosis. Your health care provider will typically recommend other, less invasive treatment options first.

Additional Pain Management Options

How people experience pain and approach pain management varies from person to person. How you choose to manage pain may depend on affordability, the options available in your area, the providers you trust, your beliefs, and your values. It also will depend on what has been helpful to you in the past or what has made your pain or endometriosis symptoms worse.

Non-hormonal medical management may include:

• Non-steroidal anti-inflammatory drugs (NSAIDs), which are inexpensive, over-the-counter, non-addictive medications. NSAIDs provide pain relief and reduce inflammation. Typical NSAIDs are ibuprofen, aspirin, and naproxen. Long-term use of NSAIDs can result in gastrointestinal bleeding, so it is important to speak with a trusted health care provider to discuss proper use.
• Pain modifiers, like anti-depressants, may also be recommended. While they are mainly used to treat depression, they have also been found to impact the ways the body manages pain.
• Opioids may be effective for short-term or post-surgical pain relief, but they are addictive and can increase risk of pain, constipation, depression, and anxiety. Opioids may make you drowsy and impact your ability to drive safely or operate heavy equipment. It is also important to speak with your health care provider if you are (or are planning to become) pregnant as opioids can have effects of the developing baby.
• Cannabis can reportedly help with endometriosis symptoms including gastrointestinal symptoms, pain relief, and mood. The mechanisms for pain relief associated with cannabis are not entirely understood and effectiveness may differ depending on method of ingestion or the amounts of THC and CBD consumed. Cannabis can impact your ability to drive safely or operate heavy equipment. If you are (or are planning to become) pregnant, it is important to speak with your health care provider as cannabis can have effects on the developing baby.

Non-medical management options may also be helpful to you. These include:

• Heat: A hot water bottle, heating pad, or hot towel on your abdomen or lower back can be helpful.
• Transcutaneous electrical nerve stimulation (TENS): A small device that sends an electrical current across the skin and to the nerves. TENS units are mostly portable and come with several settings so you can adjust the frequency of pulses, the duration of each pulse, and the intensity of the pulse.
• Physiotherapy: Particularly with a focus on pelvic health, physiotherapy can help strengthen the pelvic floor muscles. A physiotherapist can also suggest relaxation techniques and exercises to reduce pain and manage pain.
• Counselling: Can help build mindfulness techniques to help reduce stress and chronic pain, give you tools to calm the nervous system, and help manage anxiety, depression, and other intense emotions and grief that can emerge from pain-related losses.

Other lifestyle considerations including diet and exercise may be helpful to reduce some of the symptoms you experience. There is no one diet or exercise routine that works for everyone. Increasing your intake of fruits and vegetables while reducing intake of certain animal proteins and alcohol may be beneficial. Exercising can also be beneficial and help improve your health overall so that your body is better able to deal with the stress it experiences from endometriosis.

There may be other techniques that work for you. For instance, acupuncture and massage therapy may also be beneficial. It is helpful to explore diverse pain management options and to reflect on the options that help improve pain and endometriosis symptoms as well as those that make your symptoms feel worse.

Talking to Your Health Care Provider

Endometriosis and its symptoms look differently for everyone. It can feel difficult, uncomfortable, or at times unsafe to talk to a health care provide about endometriosis if you have experienced medical trauma, racism, sexism, homophobia, transphobia, or other systemic oppressions. The first step in finding care may not be sharing the symptoms you experience, but finding a health care provider that you trust and feel safe to share your experiences with.

When working with your trusted health care provider, it is important to communicate the symptoms you experience including the frequency and severity of your pain. Give examples of times in which your symptoms have impacted your daily life and what you have tried to help alleviate your symptoms. If it is difficult to communicate your experience, it may be helpful to write this information down in advance of your appointment so you can share it with your provider. You may want to let your health care provider know about:

• the date of your past menstrual cycles and related symptoms you experienced;
• the symptoms you experience;
• any past diagnoses, surgeries, tests, or treatments you have received;
• your family history;
• your current medications;
• and the names and contact information for trusted health care providers you have worked with or currently work with.

It may be helpful to bring a support person who can take notes or advocate for you in your appointment.