Endometriosis – A Treatment Guide
Once you have received your endometriosis (endo) diagnosis your thoughts might quickly turn to how you can treat the condition. You might have been suffering the symptoms for a while and understandably be feeling a bit desperate for it to end. While right now there is no cure, there are several treatments focused on minimising and managing the symptoms so that you feel free to do whatever you want in life without endo holding you back.
The right treatment for you depends on many factors, from the severity of your endometriosis, to your age, whether you want to get pregnant, and how you feel about surgery. It’s up to you to decide what your boundaries are and what treatment feels right for you. Some individuals with mild endo symptoms find that treatment beyond the contraceptive pill is not necessary, while others require more specialised surgeries to manage extremely painful symptoms.
It’s important to note that there is evidence to suggest endometriosis is a progressive disease, meaning without treatment it might worsen over time. However, there is also information to suggest that in mild endometriosis cases, up to one third of the time symptoms resolve on their own. This just goes to show how important it is to be aware of what’s going on in your body and know there’s no one-size-fits all treatment.
It’s a good idea to have an overview of all the different treatment possibilities so you can evaluate which path you might want to go down. After all, arming yourself with information is one way to take your power back in this situation. Let’s take a look at what you can expect from some of the treatment options.
Pain medication. Some simple anti-inflammatories, like paracetamol and ibuprofen, can help relieve mild painful symptoms. In the UK these are available on prescription or to buy in any supermarket or pharmacy. You may also be prescribed codeine-based painkillers, which are a bit stronger but can also cause stomach upset and constipation, which might make you feel worse if you already suffer from gastro-intestinal symptoms.
Keep it comfortable. Don’t under estimate the power of a hot water bottle or hot bath, which can help soothe pain and relax the muscles. Trying to minimise stress, especially in relation to your pain, is also important. Mental health management is an aspect of endo treatment that shouldn’t be overlooked. For more info on mental health management and endometriosis, check out our blogpost here.
Physiotherapy. Movement, tailored exercise, and relaxation techniques can strengthen the pelvic floor muscles and reduce pain over all. Physiotherapy can also be a tool for stress and anxiety management. In preparation and recovery from surgery, gentle exercises like yoga and pilates may also be helpful to strengthen the muscles and provide relaxation.
Hormones are closely linked with endometriosis, which goes through a similar cycle to the menstrual cycle. The hormone oestrogen has been found to encourage the growth and shedding of
endometriosis tissue. Hormone treatment is used to limit or stop oestrogen production and therefore reduce the amount of endo tissue in the body. This can be an effective method of treating endometriosis symptoms, especially pain. Although, it should be said that while hormone treatments can limit tissue growth, they can’t stop adhesions (the sticky tissue that can fuse organs together) and they don’t affect fertility.
The most common hormone-based treatments are:
This pill contains oestrogen and progestogen and can provide relief from milder symptoms. It works by stopping ovulation and making periods lighter. Several Studies have shown people with endometriosis who take a contraceptive, such as the combined oral pill, have reported relief from pain.
There can be some not-so-nice side effects to the pill, like bloating, weight gain, and bleeding between periods. This usually settles down after a couple of months when your body gets into the swing of things but don’t ignore it if it’s making you unhappy; there are different brands of the pill that might work better for you.
The contraceptive pill is often recommended since it can be taken over a long period of time, providing some long-term symptom relief. However, this is only while the pill is being actively taken – when the treatment stops the symptoms of endo may return.
These are synthetic hormone therapies that mimic the role of the natural hormone, progesterone. These can come in the form of a contraceptive implant, injection, pill, and non-contraceptive progestogen tablets.
This treatment prevents the lining of the womb and endometriosis tissues from growing quickly. They also reduce menstrual flow and, in some cases, can stop bleeding altogether.
In a 2017 study, Dr Robert F Casper praised the progestogen only pill, “Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills”. This could be because endometrial tissue doesn’t thicken as much without oestrogen and, unlike the combined contraceptive pill, progestogen therapies don’t contain any oestrogen. Progestogen has been found to help control pain in around 75 percent of people with endometriosis.
They can also have some unpleasant side-effects, such as mood changes, acne, and bloating. This varies a lot from person to person so it’s important to keep a track of your over-all health, especially when you first start the treatment. An easy way to do this is through symptom tracking on our SORA app, helping you to stay mindful of what’s going on in your body.
The most common surgery options attempt to remove or destroy areas of endometriosis. They are usually carried out via laparoscopy, also known as keyhole surgery. The two main forms of surgery are known as excision surgery and ablation surgery. The surgeries can help to manage symptoms and also improve fertility in some cases.
This involves cutting out and removing endometriosis lesions, while you are under general anaesthetic, with the aim to leave nothing behind. It is a more invasive method than ablation and usually takes longer to recover from. It’s a more complex surgery too, requiring a more specialised training for the surgeon. Endometriosis can still return or it may not be possible to remove the full area of tissue but this is less likely than with ablation surgery.
This means using heat, freezing, or radiosurgery to destroy endometriosis lesions. Typically, there is some scar tissue left behind and the endometriosis might only be superficially destroyed on the surface, leaving the roots behind. The surgery is less specialised and there are more surgeons trained in the technique.
Both types of surgery can provide relief from symptoms, however, the general consensus is that excision surgery can achieve better results than ablation surgery. A 2017 review of the two surgeries found that at 12 months post-surgery, excision surgery provided significantly greater chronic pelvic pain relief than ablation surgery.
These two surgeries are considered to be more extreme options, often only carried out as a last resort because they are irreversible treatments. They should also only be considered if you are not planning on having children.
The hysterectomy is the removal of the womb, carried out under general anaesthetic, and can be done with or without removing the ovaries. However, leaving the ovaries can increase the chances of endo returning.
An oophorectomy is the removal of the ovaries, this can be just one ovary, known as a “unilateral oophorectomy” or both ovaries, called a “bilateral oophorectomy”. This is also an irreversible surgery and you will experience menopause if both ovaries are removed.
If you have both ovaries removed you might also be recommended hormone replacement therapy (HRT) until you reach the age of menopause, around fifty. This is because the sudden drop in oestrogen can cause pre-menopause symptoms worse than a natural menopause, such as thinning bones and risk of osteoporosis. These surgeries are both options for symptom relief, although pain can return in approximately 15 out of 100 people who have the surgery. They are major surgeries so you will need a lot of time recover physically and mentally. Recovery can take anywhere between 4 to 12 weeks and you should build back up to everyday tasks very gradually.
Take your time.
If you are experiencing a great deal of pain, surgery could feel like a necessary treatment in the moment. However, it is important to be entirely sure of your decision as there are always risks associated with performing surgery, especially with hysterectomy or oophorectomy. Before your decision is made try to work with your gynaecologist or GP and explore all the options in depth so you can make the choice as clearly as possible.
Preparation is key.
You might try several different treatment options before finding something that is a good fit for you. Making sure you are well-prepared physically and emotionally for the potential outcomes of each treatment will help to make the process more manageable. At Syrona, we are here to support you with all the info you need to make informed choices and have CBT therapists on hand because your emotions also matter.
Keep evaluating how your treatment is working for you too. As time goes on and your priorities shift, such as potentially wanting to start a family, you might also explore different treatments. Every individual with endo has a different experience so there really is no right or wrong. Ultimately, the final say is always yours.