Endometriosis occurs when tissue that resembles the uterine lining grows elsewhere in the body.
This tissue may, for example, form on the fallopian tubes, ovaries, bowel, or bladder, and even the lungs.
Endometrial tissue gets thicker at the start of a period and sheds during it. In someone with endometriosis, the endometrial-like tissue elsewhere in the body also starts to drop away during this time. This can cause pain and cramping, and scar tissue may form.
The unfortunate truth is that there is no known cure for this condition; however, some medical treatments and holistic health practices can relieve the pain and discomfort and potentially put endometriosis into remission.
What are the treatments for endometriosis?
Healthcare providers consider several factors when determining the best treatment for endometriosis symptoms, including:
The severity of the symptoms
The severity of the condition
Whether you want children
While there is still a lack of research in this area, endometriosis presents differently in people; thus, not all treatments work well for those with endometriosis.
Symptoms may return after the treatment is stopped or, in the case of surgery, as more time passes after the procedure.
Types of endometriosis surgery
Endometriosis surgery falls into two categories: surgery to remove endometriosis while preserving the uterus and surgery to remove the uterus.
In people who want to become pregnant or preserve their fertility, surgery will focus on removing the endometrial-like tissue. This is the most common and conservative form of surgery.
The surgeon’s goal is to remove adhesions and lesions. Adhesions are bands of scar tissue that stick together when the endometrial-like tissue grows on the organs.
The two most common general surgical approaches are:
Laparoscopy: This minimally invasive procedure, also called ‘keyhole surgery,’ involves a surgeon making a very small incision, often in the belly button. Through this, they will insert a scope with a camera to look for endometriosis lesions. If they find endometriosis, they will create another incision and use a tool to remove the tissue. In some cases, they will use a robot to assist in the surgery.
Open surgery: A surgeon will make a larger incision in the abdomen and manually remove any endometriosis tissue. This surgery usually has a longer recovery time, so most doctors prefer the laparoscopic approach.
Removing the uterus (hysterectomy)
A hysterectomy removes the uterus along with the endometrial-like tissue, reducing the risk that endometriosis will return.
It is only a viable strategy for people who do not want to have any or any more children and are prepared to go through menopause.
Removing the uterus does not eliminate the chance that endometriosis will recur. Even after a hysterectomy, endometriosis can grow back.
A surgeon can perform a hysterectomy either through the vagina, which is typically a less invasive method or through the abdomen. In some cases, they may leave the ovaries, but in others, they will remove the ovaries, uterus, fallopian tubes, and cervix.
Success rates of endometriosis surgeries
The success of endometriosis surgery varies and depends on the type of surgery, the severity of the endometriosis, and where it is in the body.
Sometimes, a surgeon is not able to remove all of the endometrial-like tissue at once. Even when they do, the tissue will likely grow back over time.
A doctor may prescribe hormonal birth control to slow the growth of new endometrial-like tissue and reduce the need for future surgeries.
The outlook for fertility after endometriosis surgery is very positive.
Between 45 and 75% of women who undergo the surgery are able to conceive after healing. Many of these pregnancies are even achieved unassisted.
Although improving fertility after endometriosis surgery isn't a guarantee, the action of removing damaging, accessible tissue from vital parts of the reproductive organs is an essential step to repairing reproductive health.
As a rule of thumb, if pregnancy does not occur after 6 months post-surgery, additional endometriosis fertility treatments can be introduced to increase the odds of pregnancy.
For example, one may consider IVF to help achieve pregnancy.
With that in mind, it's important to remember that the chances of endometriosis resurfacing after surgery are between 20% and 40% within 5 years.
The likelihood of regrowth means that only a small window of opportunity is available in many cases, so choosing the best team to carry out your surgery will make all the difference when it comes to starting the family of your dreams.
Treatments for endometriosis pain
Hormone therapy for endo pain
Estradiol is a type of estrogen that regulates how uterine tissue grows. It is associated with the development and progression of endometriosis adhesions in and around the abdomen.
By prescribing medications that reduce or better regulate estrogen levels, it can help reduce pain and other symptoms.
Hormone therapy is used to treat endometriosis-associated pain. Hormones come in the form of a pill, a shot or injection, or a nasal spray.
Hormone treatments stop the ovaries from producing hormones, including estrogen, and usually prevent ovulation.
This may slow the growth and local activity of both the endometrium and the endometrial lesions. Treatment also prevents new areas and scars (adhesions) from growing, but it will not make existing adhesions disappear.
For someone trying to get pregnant, hormonal contraception will prevent the pregnancy from happening so other options may have to be reviewed with a doctor.
Pain medications for endo
Pain medications may work well if pain or other symptoms are mild. These medications range from over-the-counter pain relievers to strong prescription pain relievers.
The most common types of pain relievers are nonsteroidal anti-inflammatory drugs, also called NSAIDS.
Evidence on the effectiveness of these medications for relieving endometriosis-associated pain is limited.
Understanding which drugs relieve pain associated with endometriosis could also shed light on how endometriosis causes pain.
It should be noted that pain medications can prevent blood from coagulating (clotting), which is why they should not be taken frequently or over long periods of time.
Surgical treatments for endo
Research shows that some surgical treatments can provide significant, although sometimes short-term, relief from endometriosis-related pain, which is why healthcare providers may recommend surgery to treat severe pain from endometriosis.
During the operation, the surgeon can locate any areas of endometriosis and examine the size and degree of growth; he or she also may remove the endometriosis patches at that time.
It is important to understand what is planned during surgery because some procedures cannot be reversed, and others can affect fertility.
Therefore, individuals with endo should discuss all available options with their healthcare providers before making final decisions about treatment.
Doing nothing – no treatment
Symptoms may remain unchanged or deteriorate
Simple pain relief
Ibuprofen use has some health risks, including irritation of the lining of the stomach
The combined contraceptive pill
(temporary menopause-inducing medications) – used with or without hormone replacement ‘add-back’ (HRT)
Hysterectomy and removal of endometriosis
Lifestyle changes that could improve endometriosis symptoms
Endometriosis is often associated with increased inflammation, an imbalanced immune response, and high levels of estrogen, and sometimes one or more of these at the same time.
Because the root cause of endometriosis along with varying lifestyles and behaviors differ from person-to-person, it may take some trial and error over time in order to figure out what lifestyle modifications and pain management techniques work best for you.
Getting immediate pain relief
Warm baths, hot water bottles, and heating pads can give quick relief from endometriosis pain.
Things to help you manage your symptoms
Research has shown a link between endometriosis and diets high in fiber, leafy greens, and fish can help symptoms.
Meanwhile, diets filled with sugary foods, fruits, and red meat may make symptoms worse.
The two main reasons for this are rooted in the connection with hormonal imbalances through insulin as well as inflammation.
Endometriosis is an estrogen-dependent disease, and studies now suggest many with endometriosis are estrogen-dominant, it is advised to reduce estrogen levels, rather than increase them.
The reason to avoid sugary foods as well as foods like pasta, bread, and fruit juices is that they create spikes a hormone you’ve probably heard of: insulin. Not only can insulin create hormonal imbalances (namely estrogen!) in addition to creating an inflammatory response - double whammy.
Some experts believe that another culprit for hormonal imbalance comes from high fat in meats like beef that encourage your body to produce chemicals called prostaglandins, which may lead to more estrogen production.
This extra estrogen could be what causes excess endometrial tissue to grow.
To counteract hormonal imbalances and inflammation, it could be beneficial to include more whole foods that reduce inflammation and don’t spike your insulin levels.
That means leafy greens, fish (full of omega-3s), walnuts, and spices like Tumeric, ginger, cinnamon, etc.
One study showed that women who ate the highest amount of omega-3 fatty acids were 22% less likely to develop endometriosis than those who ate the least.
Another reason to get high-quality fiber in your diet through leafy greens, etc, is that it helps your body excrete extra estrogen, which can accumulate in the body.
The last and lesser researched factors are caffeine and alcohol. Drinking caffeinated coffee and soda seems to increase your chances of developing endometriosis, although researchers aren’t sure why. Alcohol is also associated with a higher risk.
There are a lot of reasons exercise is a great way to manage your endometriosis.
Working out encourages your heart to pump blood to all your organs, improve circulation, and help nutrients and oxygen flow to all your systems.
Those who also exercise may have less estrogen and have lighter periods, which can help improve symptoms of endometriosis over time.
Exercise can help reduce stress. And because it releases brain chemicals called endorphins, it can actually relieve pain.
Even just a few minutes of physical activity that makes you breathe hard or sweat can create that effect.
Lower-intensity workouts like yoga can be beneficial, too, by stretching the tissues and muscles in your pelvis for pain relief and stress reduction.
“For me, the biggest things that have helped are eating enough fiber, walking outside daily for 30min to get the lymphatic system moving, and drinking plenty of water. These are simple, free, and helped me put my endo into remission for years.” - Megan W., ELANZA Endo Patient Panel
Researchers think stress can make endometriosis worse. In fact, the condition itself might be the cause of your stress because of the severe pain and other side effects.
“The biggest and most challenging aspect of endometriosis was the mental component. Pain makes you exhausted.
I spent a lot of time being angry. I was angry and stressed that this was happening to me. I was angry that it took so long for me to finally find a doctor that acknowledged my pain.
And, I was stressed and upset about the fact that there weren’t any solutions that didn’t involve me getting my entire uterus removed.
The most important things I did were just to focus on my daily walks and surrounding myself with supportive friends.” - Megan W., ELANZA Endo Patient Panel
Finding ways to manage stress -- whether it’s through yoga or meditation, or by simply carving out time for self-care -- can help you ease symptoms. It may also be helpful to see a therapist who can offer tips for dealing with stress.
Another solution for long-term stress management is wellness coaching.
The premise of this intervention focuses on 1:1 sessions with a coach in which you are given the space to identify stress triggers and then shift or reframe them into areas within your control.
At ELANZA, coaches pull from neuroscience, positive psychology, and wellness coaching in order to help people reduce stress by 17%. This mental mind shift can help you both improve your stress levels and create a sense of agency while you’re navigating the long journey of endometriosis.
Consider alternative therapies:
Although there isn’t enough research that supports the use of alternative natural therapies for endometriosis, some find relief from their symptoms through these techniques, including
Some researchers have compared the effects of electroacupuncture to western painkillers for endometriosis.
They found that both methods reduced pain, with slightly more reduction in the acupuncture group. Interestingly, the women were reviewed after one year and the recurrence rate was significantly lower in the acupuncture group.
This suggests that rather than just masking pain, acupuncture may reduce the root cause of the pain.
Herbal medicine and supplements
Proponents of herbal medicine argue that herbal remedies can regulate estrogen levels, slow the growth of endometriosis implants, or ease pain.
No studies, however, have determined precisely how herbal remedies work. Instead, research has focused on whether certain supplements can reduce symptoms.
Research suggests that some herbal remedies for endometriosis may improve symptoms, either when a person takes these herbs alone or in combination with other drugs.
This research is still in the early stages, and some studies have not been well-designed or well-controlled. For this reason, herbal remedies remain an alternative treatment, not the primary treatment.
ELANZA is building the closest thing to a cure for endo
At ELANZA, we're building a safe place where you can be heard and understood and heal the symptoms of endometriosis.
This truly holistic program for endo helps put you in the driver’s seat, allowing you to take control of your endo.
Whether you’ve just been diagnosed, have been years struggling with pain for years, or have experienced surgery without much support, ELANZA is dedicated to providing simple, yet comprehensive access and support from endometriosis specialists, research experts, community, coaches, care navigators, physical therapists, classes, products & services.
The ELANZA Endometriosis Program includes:
Access to top endometriosis specialists
Endometriosis medication and pain management
Assessment of endometriosis surgery options
Endometriosis back pain, period pain, and ovulation pain management
Assessment tools to understand endometriosis treatments and fertility
Guidance around endometriosis and fertility options
Managing the stress and mental health from endometriosis
Natural remedies for endometriosis pain and symptom management
Tools to manage flare ups and 'endo belly'
A comprehensive treatment plan that empowers you to become an active participant in your care