What Are the Best Treatments for Endometriosis Relief?

One in 10 women of childbearing age has endometriosis. It is most often found in women in their 30s and 40s.  

The exact cause of this condition is not clear. Hormonal changes and the immune system may play a role. Family history is also a risk factor. Women with family members who have endometriosis face a higher risk. 

Other risk factors include:

• Never giving birth 
• Starting period at a young age 
• Menstrual periods that last more than seven days 
• Short menstrual cycles (27 days or fewer) 
• A health problem that blocks normal flow of menstrual blood

Symptoms of endometriosis can vary and range in severity. Pelvic pain is one of the most common symptoms. This pain often gets worse during the menstrual cycle, especially during the period. 

Other symptoms include: 

• Pain during or after sex 
• Chronic lower back and abdominal pain 
• Digestive issues, such as diarrhea, constipation or bloating during menstruation 

Many women with the condition experience no symptoms at all. 

Nearly four out of 10 women with infertility have endometriosis. Inflammation from endometriosis can damage the sperm or egg. It may also block their movement through the fallopian tubes and uterus.

Fertility treatments can offer hope, but it is important to act early. Minimally invasive surgery can ease pain and boost fertility. In vitro fertilization might also be an option. 

During a medical exam, doctors will ask about your symptoms and family history. They may perform a pelvic exam and, if needed, order imaging tests.

Doctors usually diagnose endometriosis after ruling out other causes of pelvic pain. First line treatments are non-invasive treatments, such as medications for pain relief and to reduce hormone fluctuations. 

If symptoms persist and treatments do not help, they do more tests. This often includes imaging tests like an ultrasound or MRI, and, if needed, more invasive treatments. 

Laparoscopy is the best method for a definitive diagnosis. It lets doctors view the internal pelvic region directly and look for endometriosis lesions. This minimally invasive procedure uses a small camera, called a laparoscope, that is inserted into the abdomen through small incisions.  

When doctors find lesions, they can see how far the disease has spread. They can also take tissue samples for a biopsy and excise the tissue. 

Endometriosis treatment depends on several factors, including: 

• Age 
• Severity of symptoms and disease 
• Pregnancy plans 
• Response and tolerance of medical treatment 

Choice of pain management depends on each person’s needs. Many women find relief from pain through lifestyle changes and medication.

Common ways to reduce pain include: 

• Nonsteroidal anti-inflammatory drugs (NSAIDs), which can be purchased without a prescription 
• Stronger prescription medications if necessary 
• Complementary therapies like acupuncture, yoga, and mindfulness, which help reduce stress and relax muscles 
• Physical therapy, which can help with pelvic pain 

Hormone treatment can help manage pain by regulating or suppressing menstruation. This reduces the growth of endometrial tissue and the pain that comes with it.

There are several hormonal options available. Each has its own benefits and side effects, including: 

• Oral contraceptives, or birth control pills, usually contain both estrogen and progestin. They help regulate hormone levels, manage the menstrual cycle, reduce menstrual flow and ease pelvic pain. 
• Progestin-only methods, which come as pills, injections or implants. They deliver progestin to reduce circulating estrogen levels. 
• Hormonal IUDs are devices placed in the uterus. They release progestin slowly over time and can provide long-term relief of symptoms 
• The vaginal ring is a small, flexible ring. It is placed inside the vagina and releases estrogen and progestin.

Side effects can vary for each woman. They may include mood changes, weight gain and irregular bleeding. Regular check-ups can help monitor these issues. 

Hormonal therapies may need adjustments based on how well they work and how the patient responds to them. These treatments are not suitable for women trying to get pregnant. 

Doctors may recommend surgery for severe pain if other treatments fail. Surgery may be laparoscopy or open surgery. Laparoscopy is a less invasive option for women who plan to get pregnant in the future. 

“Like all surgery, minimally invasive surgery has both benefits and risks. So, it’s important to talk to your doctor about all your endometriosis treatment options,” Dr. Tsai says. 

Laparoscopy can treat the condition by removing or destroying endometriosis growths. It is especially useful when medicine does not help or when fertility is at risk. Special instruments are used to remove or destroy endometriosis lesions.

Laparoscopy allows surgeons to operate with greater precision while preserving healthy tissue. Using a laparoscope, they can view the pelvic organs on a screen for enhanced accuracy. 

“The camera projects images onto a video screen that help the surgeon look for the endometriosis and remove it,” Dr. Tsai says. 

A hysterectomy is a surgery that removes part or all of the uterus. It is the second most common surgery for women, after C-sections. This surgery is done when other treatments do not work and keeping the ability to have children is not a concern. 

There are different types of hysterectomies, including robotic hysterectomy.

Sometimes, doctors also remove the ovaries during this surgery. This is known as oophorectomy.

Managing endometriosis often requires a long-term strategy. This may include surgery and hormone treatment. The goal is to reduce the chances of symptoms coming back. Regular follow-ups with your doctor are important to check your condition and adjust treatments if needed.

Some lifestyle changes include eating healthy, exercising regularly, managing stress, and avoiding alcohol and caffeine. It is also important to not smoke and to maintain a healthy weight.

“Lifestyle changes are also key for managing endometriosis. They can improve well-being and quality of life,” says Dr. Tsai. “While these changes do not cure endometriosis, they can help lessen symptoms. They can also make medical treatments more effective.”