Your healthcare provider will help create your treatment plan for endometriosis based on a few factors, including:
- The severity of your endometriosis.
- Your plans for future pregnancies.
- Your age.
- The severity of your symptoms (often pain).
In many cases, your treatment plan will focus primarily on managing your pain and improving fertility issues (if you are planning on a future pregnancy). This can be done through medications and surgery.
Medications are often used to help control the symptoms of endometriosis. These can include pain medications and hormone therapies.
Hormonal options for suppressing endometriosis can include:
- Birth control: There are multiple forms of hormonal suppression options including combination options using estrogen and progesterone or progesterone-only options. These come in multiple forms including oral birth control pills, patch, vaginal ring, birth control shot, Nexplanon implant or IUD. This hormonal treatment often helps people have lighter, less painful periods. These are not options for patients attempting pregnancy.
- Gonadotropin-releasing hormone (GnRH) medications: This medication is actually used to stop the hormones that cause your menstrual cycle. This basically puts your reproductive system on hold as a way to relieve your pain. GnRH medications can be taken as an oral pill (by mouth), a shot or a nasal spray.
- Danazol (Danocrine®): This is another form of hormonal medication that stops the production of the hormones that cause you to have a period. While taking this medication for endometriosis symptoms, you may have the occasional menstrual period, or they might stop entirely.
- With all of these medications, it is important to note that your symptoms can come back if you stop taking the medication. These medications are not recommended during pregnancy or if you are actively attempting to achieve pregnancy. Talk to your healthcare provider about the pros and cons of each medication before starting.
Medications for endometriosis pain relief can include:
- Over-the-counter pain relief.
- Non-steroidal anti-inflammatory drugs (NSAIDs).
In some cases, your provider might recommend surgery as a way to confirm and treat endometriosis. There are always risks to a surgical procedure. However, surgery for endometriosis can be an effective way to relieve pain and, in some cases, improve your fertility.
Endometriosis is considered a chronic disease. Many people experience relief from endometriosis pain after surgery, but the symptoms may return within a few years. The severity of your endometriosis could play a part in how quickly — if at all — it comes back after surgery. Your provider might suggest combining a surgical procedure with medications for the best outcome. Your provider may recommend pelvic floor physical therapy with or without medications for central nerve pain.
Surgical options to treat endometriosis include:
- Laparoscopy: In this procedure, your surgeon will make a very small cut in your abdomen (< 1 centimeter) and insert a thin tube-like tool called a laparoscope into your body. This tool can be used to see inside your body and identify endometriosis with a high-definition camera. Additional 5-millimeter instruments can then be used to excise and remove lesions.
- Hysterectomy: In severe cases, your surgeon may suggest removing your uterus based on the amount of endometriosis and scar tissue present, if you have other uterine conditions like adenomyosis and your desire for future fertility. If you have a hysterectomy, areas of endometriosis should still be excised to optimize your pain relief.
- If you have endometriosis and are trying to achieve pregnancy, in vitro fertilization (IVF) may help you achieve this goal.
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Can endometriosis go away on its own?
In some cases, endometriosis can go away on its own. Over time, endometriosis lesions can occasionally get smaller, and you may have fewer of them. This can also happen after menopause, which is often related to a drop in the amount of estrogen in your body.
For many people, endometriosis needs to be continuously treated to control symptoms like pain. It is important to maintain a regular appointment schedule with your healthcare provider so that you can work together on managing your condition long term.
What happens if endometriosis is left untreated?
Over time, the endometrial-like tissue that grows outside of your uterus can cause cysts, adhesions and scar tissue. This can cause you to experience long-term (chronic) pain — especially during menstrual periods. Many people with endometriosis may also have difficulties getting pregnant. Treatment can sometimes help with this issue.
As you age and go through menopause, the symptoms of menopause may improve. This is related to the hormonal changes your body goes through during menopause.
Prevention
Can endometriosis be prevented?
Endometriosis is not a condition you can necessarily prevent. There are certain factors that can reduce your risk of developing the condition, but in some cases, you may still have endometriosis. There could be a genetic reason that some people develop endometriosis. If other people in your family (mother or grandmother) have been diagnosed with endometriosis, talk to your provider about your risk of also developing the condition.
A few factors that can reduce your risk of endometriosis include:
- Pregnancy.
- Breastfeeding.
- Maintaining a weight that is healthy for you.
- Starting your menstrual period at a later age.
Outlook / Prognosis
What are the complications of endometriosis?
There are several medical complications that can happen if you have endometriosis. People with endometriosis may experience fertility issues (difficulty getting pregnant). This can sometimes be helped with treatment options like medications, surgery for endometriosis or fertility treatments like IVF.
People with endometriosis can also experience bowel or bladder issues. These may include pain with voiding or with bowel movements, or seeing blood in your urine (pee) or stool (poop). With severe endometriosis of your ureter (the tube that carries urine from your kidney to your bladder), you can occasionally get swelling of your kidney. Endometriosis can occasionally impact your lung or diaphragm, which can lead to shortness of breath, chest pain or lung collapse during menstrual cycles. Chronic (long-term) pain is another issue related to endometriosis. Your healthcare provider will work with you to manage these issues to improve your daily life.
Can I get cancer from endometriosis?
Endometriosis is associated with a small increased risk of developing epithelial ovarian cancer, mainly including clear cell and endometroid carcinomas. This risk is extremely low and no preventative screening is currently recommended.
Can you get pregnant if you have endometriosis?
You can get pregnant if you have endometriosis. However, people with endometriosis can have a difficult time getting pregnant. This condition can be a common cause of infertility. If you have endometriosis and want to get pregnant, talk to your healthcare provider about the best treatment option for you. You might need to change your medication or, in some cases, pursue a surgical option to treat your endometriosis. Your provider will work with you to find the best treatment plan to help support a pregnancy.
Can you still have endometriosis after menopause?
Menopause is a time of major change in your body. One thing that happens during this transition is a change in the levels of hormones in your body, specifically estrogen. There is a link between your reproductive hormones and endometriosis. After menopause, with decreased estrogen levels, endometriosis lesions often decrease. This can also mean that you no longer experience symptoms of the condition or that they are less intense than before menopause.
However, if you take hormones as a treatment for any symptoms you experience during menopause, your endometriosis may still cause symptoms.
