Goals for endometriosis treatment include alleviating pain, minimizing organ damage and preserving a woman’s fertility (if desired). Treatment is very individualized and depends on a woman’s age, the severity of her symptoms and her plans for future pregnancy. Pain is the most common reason women seek treatment for endometriosis.

Women with mild or no symptoms who do not want to become pregnant may choose no treatment. Women who want children may be encouraged to try to become pregnant sooner rather than later because the negative effects of endometriosis on infertility may increase with age. In addition, it was formerly thought that pregnancy can reduce the condition’s symptoms. However, recent studies indicate that pregnancy does not alleviate symptoms and symptoms may return after pregnancy for many women.

Studies have not proven the best method for treating pelvic pain, but medical treatment options for endometriosis include:

• Pain medication (analgesics). Over-the-counter anti-inflammatory medications can provide relief for mild to moderate pain. However, they cannot change or remove any endometrial implants. Physicians may prescribe narcotic painkillers for severe endometriosis pain. These medications are used to alleviate symptoms, but do not have an impact on the underlying condition.
  
  
• Birth control pills. Endometrial lesions respond to hormones, including the estrogen and progestin usually found in birth control pills or patches. Therefore, these medications may lessen the severity of symptoms. Symptoms may return when a woman stops taking the medication because it does not have an impact on the underlying condition (scarring and adhesions). Birth control pills may have side effects, including nausea and mild weight gain.
  
  
• Other hormonal treatments. Hormone therapy can produce the same effects as menopause or pregnancy. The goal is to stop menstruation, which can take several months. Hormonal treatments may minimize endometrial symptoms and shrink implants, but will not affect any scarring or adhesions that have already formed. They are rarely effective in women with severe endometriosis. Hormonal treatments include:
  
  
• Progesterone. A synthetic form of progestin that may be taken as pills or injections. It may control symptoms by reducing or stopping menstruation and stopping ovulation. Side effects include weight gain and mood changes. Progesterone is administered as a daily pill or in periodic shots. Progesterone may not be recommended for a woman who wants to become pregnant. Return of ovulation may be delayed after progesterone therapy has stopped. Ovulation may take up to a year to return after progesterone injections.
  
  
• GnRH agonists. These are synthetic drugs similar to the natural gonadotrophin releasing hormone (GnRH), which induce a chemical menopause. They are administered as a nasal spray or an injection. GnRH agonists are usually prescribed for only six months because they increase the risk of bone loss that may lead to osteoporosis. Side effects are similar to symptoms of menopause, including hot flashes, vaginal dryness, loss of bone density and insomnia. Most women with severe cases of endometriosis who are treated with GnRH agonists will experience recurrent pain after discontinuing use.
  
  
• Synthetic androgens. Medications (such as danazol) that are similar to male hormones (androgens) affect the production of female hormones and stop menstruation. These hormones are taken as pills for six to nine months. Some side effects include acne, weight gain and hirsutism (growth of facial or body hair). Some of these side effects may not reverse after the medication is discontinued. Androgens should not be taken by women with certain types of liver, kidney or heart disease because it can worsen those conditions.

All these hormonal treatments can affect an embryo and women must take steps to avoid pregnancy during the treatments. Because birth control pills may not be used in combination with the other hormonal treatments, a woman should use another method of contraception (e.g., condoms) with any of these treatments. When the treatments are complete and menstruation returns, a woman may attempt to become pregnant. Patients may experience a recurrence of endometriosis symptoms after hormonal treatments stop.

Physicians consider surgery for endometriosis when there are advanced adhesions and scarring or when medical therapy has not alleviated symptoms, such as severe pain. There are several surgical options for endometriosis:

• Conservative surgery. Involves removing the endometrial implants while maintaining the reproductive organs. This is the preferred surgical treatment for endometriosis. The patient is sedated with anesthesia and a surgeon performs a laparoscopy or laparotomy to remove the implants by heat, laser or excision (cutting them out). Excision is the preferred method because it allows the lesions to be examined in a biopsy. Surgeons can also correct the position of any organs (e.g., ovaries) that may have become displaced because of the adhesions.
  
  Adhesions around the organs can be cut, and at times blocked fallopian tubes can be repaired. These procedures may involve removing one ovary, but no other organs, so a woman may still be able to have children. Many women are able to become pregnant after conservative surgery, depending on the severity of the endometriosis before the surgery. Damage to the inside of the fallopian tube from endometriosis can result in a woman requiring in vitro fertilization (IVF) to become pregnant. Symptoms may still recur after surgery and some women have repeated laparoscopies or laparotomies.
  
  
• Laparoscopic uterosacral nerve ablation (LUNA). This procedure involves cutting a nerve between the uterus and the ligaments that hold it in place. It may help women with a specific type of pain, but studies show that many women experience no pain relief. Any severing of nerves is permanent and cannot be reversed.
  
  
• Hysterectomy. This procedure removes a woman’s uterus. For endometriosis, surgeons also remove the ovaries and fallopian tubes (bilateral salpingo-oophorectomy) and any implants or adhesions. Hysterectomy usually ends the endometriosis symptoms, but also ends the possibility of childbearing. It is considered a treatment of last resort. After removal of the ovaries, a woman begins menopause because her body no longer produces estrogen. Although the surgery may alleviate the endometriosis symptoms, the surgical menopause will create other symptoms such as hot flashes, weight gain and vaginal dryness. Surgical menopause caused by hysterectomy may cause more severe symptoms than those from natural menopause. After a hysterectomy, a woman will usually be prescribed estrogen replacement therapy.

With all endometriosis treatments, the condition may recur and the pain may return, although it is uncommon after hysterectomy. Some women are able to get pregnant naturally after conservative surgical treatment for endometriosis. Others are able to become pregnant using assisted reproductive technology (ART). An obstetrician can best discuss fertility options with a patient and her partner. 

There is no cure for endometriosis. A woman may consult with her physician to determine the best course of treatment for the disease, its symptoms and her fertility. Cost of treatment may be a consideration. Some hormone therapies such as GnRH agonists are extremely expensive, as are repeated surgeries.

There are no known methods to prevent endometriosis. The disease usually continues unless it is interrupted by pregnancy or treated with some form of therapy. It can recur with all treatments, though some are more effective than others. At menopause, the symptoms may lessen in many women. The effect of hormone replacement therapy in women with endometriosis who reach natural menopause is unknown.

In addition, the herbal supplement Pycnogenol – a plant extract from the bark of the French maritime pine tree – may significantly reduce pain symptoms (e.g., pelvic pain, dysmenorrhea) in endometriosis patients, according to a new study. Pycnogenol is commercially available in numerous health food stores and other nutrition venues. However, health experts recommend caution when using herbal supplements since sufficient studies have not been conducted to determine their long-term safety or efficacy for treating any health condition. Patients are urged to consult a physician before taking any herbs or nutritional supplements.