From the Guidelines
Treatment options for endometriosis include both medication and surgical approaches, with the goal of reducing symptoms and improving quality of life, as recommended by the American College of Obstetricians and Gynecologists (ACOG) 1, 2, 3, 4.
Medical Treatment Options
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg twice daily) for pain management
- Hormonal therapies, including combined hormonal contraceptives (pills, patches, or rings), which can be taken continuously to prevent menstruation
- Progestins like norethindrone acetate (5-15mg daily), medroxyprogesterone acetate (30-100mg daily), or the levonorgestrel IUD provide symptom relief by suppressing endometrial growth
- GnRH agonists such as leuprolide (3.75mg monthly injection) or GnRH antagonists like elagolix (150mg daily or 200mg twice daily) create a temporary menopause-like state to reduce estrogen levels, though these typically require "add-back" therapy with low-dose hormones to prevent bone loss if used beyond 6-12 months ### Surgical Treatment Options
- Laparoscopic surgery to remove or destroy endometrial implants may be recommended for severe cases or when fertility is desired
- Surgery for women with endometrial pain is associated with significant reduction in pain during the first six months following surgery, although up to 44 percent of women experience a recurrence of symptoms within one year 2 ### Treatment Choice
- Depends on symptom severity, fertility desires, side effect profiles, and patient preferences
- For pain relief, treatment with a GnRH agonist for at least three months or with danazol for at least six months appears to be equally effective in most women, as supported by Level A scientific evidence 2
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Therapy with norethindrone acetate tablets must be adapted to the specific indications and therapeutic response of the individual patient. ... Endometriosis Initial daily dosage of 5 mg norethindrone acetate tablets for two weeks. Dosage should be increased by 2. 5 mg per day every two weeks until 15 mg per day of norethindrone acetate tablets is reached. INDICATIONS AND USAGE Norethindrone Acetate Tablets, USP are indicated for the treatment of secondary amenorrhea, endometriosis, and abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology, such as submucous fibroids or uterine cancer.
The treatment option for endometriosis is norethindrone acetate (PO), with an initial daily dosage of 5 mg for two weeks, increasing by 2.5 mg per day every two weeks until 15 mg per day is reached, as stated in 5. Norethindrone acetate tablets are indicated for the treatment of endometriosis, as mentioned in 6.
From the Research
Treatment Options for Endometriosis
The treatment options for endometriosis can be categorized into several types, including:
- Hormonal therapies, which are central to the management of endometriosis 7
- Medical therapies, which are often the first line of management for women with endometriosis 8
- Surgical therapies, which may be recommended in certain cases, such as infertility or severe symptoms 9
Hormonal Therapies
Hormonal therapies for endometriosis include:
- Combined oral contraceptives (COCs), which are effective in reducing dysmenorrhea, but may not prevent disease progression 7, 10
- Progestins, such as dienogest, which demonstrate superior long-term efficacy with favorable side-effect profiles 7, 8
- Gonadotropin-releasing hormone (GnRH) agonists and antagonists, which are reserved for second-line treatment due to side effects and hypoestrogenism, but can significantly reduce endometriotic lesions 7, 8, 11
- Levonorgestrel intrauterine system (LNG-IUS), which is especially effective in patients with adenomyosis 7, 10
Medical Therapies
Medical therapies for endometriosis include:
- Non-steroidal anti-inflammatory drugs (NSAIDs), which are widely used to relieve primary dysmenorrhea 8
- Aromatase inhibitors, which should be reserved for women who are refractory to other treatments 8, 11
Factors Influencing Treatment Choice
The choice of treatment for endometriosis depends on several factors, including: