Health A-Z

Medical Content Created by the Faculty of the
Harvard Medical School

Endometriosis

Treatment

Several different treatment options are available:

• Pain management alone — If you have mild pelvic or abdominal pain due to endometriosis, your doctor may suggest that you try a nonprescription pain medication, such as ibuprofen (Advil, Motrin and other brand names) or naproxen (Aleve). If this doesn't help, your doctor may suggest trying one of the nonsteroidal pain relievers that is available by prescription. Stronger medications that contain a mild narcotic, such as codeine, are available but are prescribed only when nonsteroidal pain medications fail or can't be used because of side effects or allergic reactions. Narcotics pose a risk of drug dependence and addiction.

• Pain management combined with control of hormone levels — Some treatments decrease the pain of endometriosis by limiting or eliminating the effects of female hormones on areas of endometrial tissue. Medications that can have this benefit include oral contraceptives, progestins, danazol (Danocrine) and medicines called "gonadotropin-releasing hormone agonists"such as nafarelin (Synarel) and leuprolide (Lupron). Gonadotropin-releasing hormone agonists act on the pituitary gland to decrease levels of female hormones dramatically. This creates a reversible "fake menopause", or pseudomenopause, which allows time for the endometriosis to fade away.

• Conservative surgical treatments (laparoscopy and laparotomy) — During laparoscopy, your doctor either will burn away small areas of endometrial tissue or use a laser to vaporize them. Your doctor also may trim away any tissue that might be twisting your pelvic organs out of their normal position. These procedures often can be done during the same laparoscopy session that is used to diagnose endometriosis. If you have more extensive areas of endometriosis, your doctor may perform traditional abdominal surgery through a larger incision instead. The larger incision will give the doctor more room to reach and treat all areas of endometriosis inside your pelvis and abdomen.

• Hysterectomy (removal of the uterus) — In women who no longer want to become pregnant, and in women with severe disabling pain, the doctor may treat endometriosis by removing the uterus, together with the ovaries and fallopian tubes. This would be a last resort when other measures have failed.

The treatment option that is best for you depends on several factors, including the severity of your symptoms and your plans for pregnancy. For example, if you have painful endometriosis and also are trying unsuccessfully to get pregnant, your doctor may recommend that you have conservative surgical treatment with laparoscopy. This option not only may improve your symptoms, but also increase the chances that you will conceive, since scar tissue that is "tethering" your tubes and pulling them out of alignment may be removed. On the other hand, if you want to postpone pregnancy, your doctor may suggest that you take oral contraceptives for a few months to see if this relieves your symptoms.