What are the treatment options available for endometriosis?

Ovaries produce hormones during your menstrual cycle that cause endometrial tissue to thicken, break down, and bleed. When endometrial tissue travels outside the uterus and goes through this process, it often causes pain and inflammation.

Hormone therapy treatments work by stopping the release of hormones from your ovaries by putting your body into a menopause or pregnancy state. The type of hormone therapy you are taking will determine which state. This is not a permanent change. Once you stop taking the hormones, your body will return to its normal menstrual cycle. You can use hormone therapy no matter what your stage of endometriosis. It is often used in conjunction with other treatments. Types of hormone therapies include:

• Combined oral contraceptive (birth control) pill
• Progestogens
• Gonadotropin-releasing hormone (GnRH) analogues
• Aromatase inhibitors.
  
   

Surgery is often recommended for the diagnosis and treatment of endometriosis. It is usually the next step if medications haven’t helped improve your symptoms or if it has been recommended when managing infertility. Although surgery can’t cure endometriosis, it can help improve fertility and provide relief from symptoms.

Studies have shown how important it is to make sure your surgeon is an endometriosis specialist.¹ Having an experienced surgeon with the necessary skills will help reduce the risk of complications and the need for multiple surgeries.

The surgeries to treat endometriosis include: 

Laparoscopy

Surgery to treat endometriosis, primarily by excising lesions. A laparoscopy is a minimally invasive procedure. Incisions are very small, making the recovery time much quicker.

Laparotomy

A major abdominal procedure with large incisions. Large incisions require a longer recovery time. A laparotomy is only recommended if endometriosis isn’t treatable via a laparoscopy, which is uncommon.

Hysterectomy

The removal of the uterus, the fallopian tubes, and often the cervix as well. In rare cases, one or both ovaries may also be removed. This operation is irreversible, which means you won’t be able to have a baby after this procedure. 

Oophorectomy

The removal of an ovary. This can be a bilateral oophorectomy (removal of both ovaries) or a unilateral oophorectomy (removal of one ovary). This operation is irreversible, which means you won’t be able to have a baby after this procedure.

¹ F Di Guardo, M Shah, M Cerana, A Biondi, E Karaman, P Torok, D Yela, P Giampaolino, A Marin-Buck and A Lagana, ‘Management of women affected by endometriosis: Are we stepping forward?’, Journal of Endometriosis and Pelvic Pain Disorders, 2019, 11(2):77-84, https://doi.org/10.1177/2284026519841520

Pain management is an essential part of managing endometriosis. Patients that don’t have effective pain management will often experience a significant impact on their quality of life. 

Patients with endometriosis may have either acute pain or chronic pain. If you’re experiencing severe pelvic pain, you must speak to your doctor. Pain is not normal and is our body’s way of telling us that something is wrong.

What can I do to manage my pain?

Analgesics (also known as pain killers) are medications that can help relieve your pain. These can include:

Paracetamol

Paracetamol is a cheap and effective pain killer. While it may not seem to be effective in severe pain, when taken early together with NSAIDs it can help to prevent the escalation of pain. 

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs help reduce pain and inflammation by blocking enzymes that lead to the production of prostaglandins. During your period, prostaglandins cause your uterus muscles to contract. If your prostaglandins levels are too high, this can cause severe contractions and period cramps.

NSAIDs are very effective in treating acute pain. They are often recommended in the early stages of endometriosis.

Opioids

Opioids are a strong pain killer that can provide relief from acute pain. They reduce pain by attaching to opioid receptors in cells located in your body. After attaching, they block pain signals to your brain and give you a sense of pleasure by increasing dopamine levels. They also slow down the body’s automatic functions, such as breathing, which helps lower pain levels.

Opioids are only available by prescription from your doctor due to their strength and the risk of addiction. You should only use opioids for short term, acute pain relief. Opioids are not recommended as a long-term treatment option for chronic pain.

Other

There are other medications used in the management of pain related to endometriosis. These neuromodulators work by different mechanisms and are effective for different types or pain and patients. Some examples include anticonvulsants, including Pregabalin and Gabapentin, and antidepressant medications including tricyclics, SSRIs, and SNRIs.

To receive an email copy of the Endometriosis Pain Management Guide, fill in your details at Epworth.org.au/EndoPainGuide

Pelvic floor dysfunction (PFD) is when you can’t control your pelvic floor muscles and is common in people with endometriosis. When experiencing severe pelvic pain because of endometrial implants, it’s common for pelvic muscles to tighten in response to this pain. 

A pelvic floor physiotherapist will provide you with an assessment of your pelvic floor muscles. Based on the results, they will provide you with a strategy to relax muscle tightness in your pelvis and restore elasticity to tissue. 

Pelvic floor physical therapy is a specialised area of physiotherapy. Our pelvic floor physiotherapists have the training needed to help you improve your pelvic floor function.

Exercise increases the anti-inflammatory and antioxidant markers within our bodies. As endometriosis is an inflammatory condition, these markers can help to calm inflammation. It also increases blood flow to your stomach and pelvis, helping to clear inflammatory by-products of inflammation. Exercise has also been found to reduce the pain response in many pain conditions and helps your physical and mental health. 

Exercise can result in pain if you don’t find an activity that suits you or if you don’t prepare your body for exercise. Your body can tighten the muscles in the pelvic area in anticipation of pain. If you’re unsure how to approach exercise, our exercise physiologists can tailor an exercise plan suited to your needs.

Nutrition is another tool you can use to help control your endometriosis symptoms. Certain foods can trigger symptoms and cause inflammation. There are specific diets that eliminate foods that are known to cause inflammation.

Gluten-free diet

Removes gluten from your diet. Gluten is a protein found in wheat, rye, and barley. Some common foods containing gluten include bread, beer, cakes, pies and cereals.

FODMAP diet

Removes FODMAPS from your diet. FODMAPs are short-chain carbohydrates that are hard for the body to digest. Common FODMAPs include dairy products with lactose and fruits and vegetables containing fructose. FODMAPS tend to trigger symptoms in people with endometriosis. Some endometriosis patients are seeing a big improvement in their symptoms after following a low FODMAP diet.²

² J Moore, P Gibson, R Perry and R Burgell, ‘Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and low response to the low FODMAP diet’, Australian and New Zealand Journal of Obstetrics & Gynaecology, 2017, 57(2):201-205, https://doi.org/10.1111/ajo.12594.

Complementary therapies can help manage endometriosis symptoms and can be used in conjunction with other treatments.

These therapies can include:

Yoga

Uses specific yoga postures, exercises and breathwork to help you with your physical and emotional needs. 

Massage

Involves manipulation and rubbing of your muscles and soft tissue. 

Meditation

Calms you by developing your concentration and improving your focus.

Guided image therapy

A relaxation technique in which people focus on an image that makes them feel relaxed and happy.

Music therapy

Uses music to help your physical, emotional, cognitive, and social needs. 

Hypnotherapy

This is a guided relaxation technique in which people are placed in a state of heightened awareness (also known as a trance). 

Naturopathy

Naturopathy uses of natural medicines to allow the body to heal itself