Sunday, October 2, 2022

For patients: what to know about endometriosis treatment

You may have been diagnosed with endometriosis based on your symptoms, pelvic exam and/or imaging such as ultrasound. The next step is treatment, which is usually based on the severity of the pain and your desire for pregnancy. Doctors have many options for treating and managing endometriosis, and some may even discuss lifestyle changes and mind-body exercises.

pharmaceutical treatment

Your doctor may initially suggest over-the-counter agents to reduce painful swelling and the size of the sores – for example, ibuprofen (Advil, Motrin) and naproxen (Aleve). There are also stronger pharmaceutical-grade anti-inflammatories, such as celecoxib (Celebrex).

All of these belong to the widely used drug class called non-steroidal anti-inflammatory drugs (NSAIDs). If you do not intend to become pregnant, the next step would be oral contraceptives to suppress ovulation and provide additional progesterone to reduce the action of estrogen on pain and the development of endometriosis.

If oral contraceptives are not effective after a few months, your doctor may prescribe a different type of hormonal therapy that more specifically targets estradiol production, such as gonadotropin-releasing hormone (GnRH) analogs such as leuprolide (Lupron). ), a GnRH agonist, or elagolix (Orilissa), a GnRH antagonist.

Both agents act on the pituitary gland to suppress the hormones that act on the ovaries to produce estrogen.

Both classes of these drugs result in varying degrees of menopause-like condition; However, this can be reduced with the addition of “add-back” therapy (usually a progestin-based pill called norethindrone acetate).


If medical treatment does not help, surgery may be needed to remove the endometriosis lesions.

The surgery is usually performed laparoscopically under general anesthesia using a thin tube with a small camera inserted into the abdomen through a small opening in the abdomen.

The surgery may involve a procedure called ablation, in which lesions and scar tissue are reduced by “burning” the tips with an energy source such as a laser or electrocautery. Surgical excision may also be used to remove lesions below the surface. Your provider will tell you which approach (or if a combination approach) will be used.

Because pain may return within several months after surgery, postoperative medical therapy is recommended, as studies have suggested that combining surgery with medical therapy is the most effective method.

lifestyle changes

For some women with endometriosis, exercise, better sleep and rest patterns, or mind-body approaches may help.

Mind-body approaches include relaxation techniques, yoga, meditation, biofeedback, and group or one-on-one cognitive behavioral therapy. These have been shown to reduce the chronic pain, fatigue, stress, anxiety, and depressive symptoms of endometriosis.

On the dietary front, foods high in fiber and the anti-inflammatory omega-3 fatty acids found in cold-water fatty fish, avocados and walnuts may help. Ask your doctor if supplements are in order.

Some women with endometriosis may find some relief by avoiding certain “pro-inflammatory” foods, such as gluten, fatty meats, caffeine, alcohol, sugary drinks and processed foods.

In addition, a diet low in fermentable carbohydrates known as FODMAPs (which stands for fermentable oligosaccharides, monosaccharides, and polyols) used to reduce irritable bowel syndrome has shown benefit in some studies. has shown.

In short, an overall healthy diet and good exercise, sleep and rest practices should be part of your plan to tame endometriosis.

Read previous installments of this series:

Part 1: What is Endometriosis?

Part 2: How will your doctor diagnose endometriosis?

A “medical journey” is a set of clinical resources reviewed by physicians, both for the medical team as well as the patients they serve. Each episode of this 12-part journey through the state of the disease includes both a physician guide and a downloadable/printable patient resource. The “Medical Journey” charts a path every step of the way for physicians and patients and provides ongoing resources and support as the care team navigates the course of an illness.

download this resource

For patients: what to know about endometriosis treatment


  • Author['full_name']

    Diana Swift is a freelance medical journalist based in Toronto.

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