Managing Endometriosis: Treatment Options Post-Diagnosis

Have you been diagnosed with endometriosis? Discover our top tips for managing endometriosis pain and the treatment options available to you. From painkillers to surgery. 

Quick facts:

• There is no cure, but several treatment options for endometriosis.
• Treatment options include pain management, hormone therapy and surgery.
• Which treatment is right for you is personal and you should consider each carefully.
• If you need support with a care plan, our experts are here to help.

Living with endometriosis

If you live with endometriosis, you probably know that one of the biggest symptoms of endometriosis is pain… a lot of it. Experiencing chronic pain amongst other, often equally debilitating symptoms, can have big physical and emotional consequences. 

Sadly, there is currently no cure for endometriosis. And with limited research and understanding of the condition, it can be difficult for both doctors and endo warriors to get a handle on managing endometriosis symptoms.  

But you don’t have to put up with pain. There are several treatments available to manage symptoms and help improve your quality of life. Lots of people report huge improvements with these treatments—it’s just about finding what works for you.

Medication for managing symptoms

The first step in managing pain is usually exploring the use of painkillers. Your doctor may recommend taking nonsteroidal anti-inflammatory drugs (NSAIDs) (aspirin, ibuprofen) or paracetamol as a first line of treatment to manage any pain. 

However, there are lots of different types of painkillers and your doctor can help you to find ones that work for you and your pain level. 

Depending on the severity of your endometriosis pain, you may try a course of painkillers for a few months until you assess whether or not they are working for you. 

But if you’re finding that these aren’t making the cut and you’re unable to go to work, uni, school, work or other plans, don’t suffer in silence! This is just the first option for managing endometriosis, so push your doctor for alternatives.

Tips for endometriosis pain management

Endometriosis UK suggests some extra tips for pain management:

Heat and comfort

Hot water bottles, heated wheat bags or special heat pads can really help to soothe pain, cramping and inflammation. 

Remember to never put them directly onto the skin and always have a layer in between. Partnered with your comfies, hopefully, this can help you to feel more comfortable.

Physiotherapy

Physiotherapists can develop a programme of exercise and relaxation techniques designed to help strengthen pelvic floor muscles, reduce pain, and manage stress and anxiety.

TENS machines

Transcutaneous Electrical Nerve Stimulator (TENS) machines are small devices with electrodes that send electrical pulses into the body. This can block the pain messages as they travel through your nerves.

Pain clinics

Your doctor can refer you to your nearest pain clinic to see chronic pain specialists. Push for your doctor to get you the expert advice you deserve to manage your endometriosis pain.

Hormone treatment for endometriosis

When you’re diagnosed with endometriosis, hormone treatment is another common avenue to explore. You should discuss hormone treatment with your doctor or specialist to decide if it’s right for you.

For those with endometriosis, similar cells to those lining the womb exist outside of the womb (usually in the abdomen). 

These cells also respond to your sex hormones, particularly oestrogen and progesterone, in the same way as your womb lining. They thicken, break down and bleed during your period. This bleeding causes inflammation and scarring, leading to chronic pain. 

Hormone treatment is commonly used to reduce the growth of this endometrial tissue. 

How does hormone treatment help endometriosis?

Hormone treatment aims to maintain low levels of oestrogen in the body, as oestrogen has been found to encourage the growth of endometrial tissue. Hormone therapy can help reduce heavy flow or even stop periods and therefore improve symptoms. 

Whilst most endo warriors find that hormonal treatment reduces their symptoms, it is not a permanent fix to manage endometriosis.

Types of hormonal treatment used to manage endometriosis?

There are lots of different types of hormone treatment available. Some of the most common are also used as contraceptive methods including:

• The combined pill (oestrogen and progesterone) 
• The mini-pill (progesterone only)
• An intrauterine system (IUS): a small T-shaped plastic device fitted into the womb and lasts for 3 to 5 years depending on the brand used. A very commonly used one is the Mirena coil. 
• Progesterone injections: They need to be taken every 8 – 13 weeks depending on the brand used. Depo-Provera, Sayana Press and Noristerat are commonly used in the UK.
• The progesterone implant: It is a small rod placed in your arm and lasts for 3 years.

Unfortunately, not everyone gets on with hormonal contraception and side effects can be common. It’s important to consider which hormone treatment is right for you.

Surgery for endometriosis

A last resort if the above treatments aren’t keeping your symptoms at bay, is endometriosis surgery. This aims to remove or destroy areas of endometrial tissue. 

This can include laparoscopic surgery or a hysterectomy. The kind of surgery you have will depend on where the endometriosis is and how much of it there is.

Laparoscopic surgery for endometriosis

Initial surgery will almost always involve gynaecological laparoscopy for both diagnosis and excision. In laparoscopic surgery, also known as keyhole surgery, your surgeon inserts a small tube with a light source and a camera, through a small incision near your belly button. 

They use this to be able to look inside your tummy or pelvis and then use fine tools to remove endometrial tissue (excision) or use intense heat to destroy the tissues (ablation). They can also remove any scar tissue that has built up in the area. 

This form of surgery can be difficult, as many of the lesions are below the surface and not visible, so a highly skilled practitioner is required to remove them. 

It might be the most long-lasting treatment, and people do notice relief in symptoms, but many who undergo surgery find their endometriosis grows back over time. This is why endo warriors may have to undergo surgeries multiple times. Hormone treatment might be used after surgery to help get better, longer-lasting results.

Hysterectomy for endometriosis

Sometimes healthcare professionals will also suggest undergoing a hysterectomy, a surgery where the womb is removed. This can be a very big decision as post-surgery, you will no longer be able to become pregnant or carry a pregnancy. 

If you want children, you can discuss egg freezing before this procedure with your doctor. This means that you will then have the option of trying to have a baby using fertility treatments such as in vitro fertilisation (IVF) with the help of a surrogate.

In some cases, someone might still experience symptoms after getting a hysterectomy done as a form of endometriosis management.

If the ovaries are also removed during a hysterectomy (oophorectomy), this stops the release of hormones. Whilst this can help with symptoms, it will put you into menopause and you might need hormone replacement therapy (HRT) afterwards to manage menopausal symptoms.

Like all types of surgery, surgery for endometriosis carries a risk of complications such as infections, bleeding, bruising, etc. You can read more about endometriosis surgery here.

How do I decide which treatment is right for me?

Deciding which treatment might work best for you is something you can explore with your doctor. Several factors are important to consider when deciding which endo treatment is right for you, including:

• Age: Younger people may prioritise less invasive treatments to preserve their fertility whilst older people may opt for more definitive treatments, such as hysterectomy.
• Symptom severity: Mild symptoms may be managed with pain medication and lifestyle changes whilst severe symptoms may require more aggressive treatment approaches, like surgery.
• Family forming: If you want to conceive, some treatments, like hormonal contraceptives may stop you from getting pregnant. If you are undergoing surgery or there is a risk that endometriosis might affect your fertility. If you plan on having children you may want to opt for fertility-preserving treatments before surgery.
• Extent and location of endometrial lesions: The location and extent of endometrial implants can influence treatment decisions. Deep infiltrating endometriosis may require specialised surgical techniques.
• Prior treatment history: The success or failure of previous treatments can guide current choices. Repeated surgeries may not be the best option for some people.
• Overall health and well-being: Your overall health and wellness can impact treatment decisions. Existing medical conditions may affect the choice of treatment.
• Potential side effects: You should weigh up the side effects of treatments against symptom relief.
• Cost and accessibility: The financial cost and the availability of treatments can influence choices. Insurance coverage or healthcare system differences can be a factor.
• Quality of life: Assessing how different treatments may impact daily life, work, and relationships.
• Research and emerging therapies: Awareness of new treatments and clinical trials. You may consider participation in research studies.

Ready to get started with treatment?

If your endometriosis symptoms are causing you pain and distress, we can help. At Hertility, we don’t believe in ignoring or masking your symptoms. 

Our team of experts include endometriosis specialists that can help you decide which treatment suits you best whether it’s surgery, hormone treatment or pain relief. Get in contact with us today and we can point you in the right direction.

If you are looking for more information on Endometriosis, our other blogs may be helpful to you:

• Endometriosis Symptoms
• Endometriosis and Fertility: What you need to know
• Living with Endometriosis: What I’ve learnt along the way

Resources:

1. https://www.nice.org.uk/guidance/ng73/resources/patient-decision-aid-hormone-treatment-for-endometriosis-symptoms-what-are-my-options-pdf-4595573197
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700667/
3. https://www.nice.org.uk/guidance/ng73/chapter/Recommendations#pharmacological-pain-management
4. https://www.nhs.uk/conditions/endometriosis/treatment/ 
5. https://www.endometriosis-uk.org/pain-relief-endometriosis