What are the treatment options for endometriosis?

Treatment Options for Endometriosis

NSAIDs and hormonal therapies are the first-line treatments for endometriosis, with surgery reserved for cases unresponsive to medical management. 1, 2

First-Line Management

• NSAIDs provide immediate pain relief and should be used at appropriate doses and schedules for optimal control of endometriosis-related pain 3, 1
• Combined hormonal contraceptives (oral, patch, or ring) are effective for pain relief and are equivalent to more costly regimens 1, 4
• Progestins are effective alternatives with similar efficacy to other hormonal treatments:
  • Oral progestins such as norethindrone acetate starting at 5 mg daily, increasing by 2.5 mg every two weeks until reaching 15 mg daily 5
  • Depot medroxyprogesterone acetate injections 1, 6
  • Levonorgestrel-releasing intrauterine system for long-term treatment 4, 6

Second-Line Management

• GnRH agonists provide significant pain relief when used for at least three months 1, 2
• When using GnRH agonists long-term, add-back therapy should be implemented to reduce bone mineral loss without reducing pain relief efficacy 1, 2
• Dienogest, a newer progestin, has become one of the most widely used drugs for all endometriosis phenotypes for long-term treatment 6
• Elagolix, a GnRH antagonist, has recently received FDA approval for treating endometriosis-associated pain 7

Surgical Management

• Surgery provides significant pain reduction during the first six months following the procedure 1, 2
• For severe endometriosis, medical treatment alone may not be sufficient, and surgical intervention should be considered 1, 2
• Up to 44% of women experience symptom recurrence within one year after surgery 1, 2
• Hysterectomy with bilateral salpingo-oophorectomy is currently the only procedure that seems to cure endometriosis 8

Special Considerations

• For women with endometriosis who required oophorectomy, combined estrogen/progestogen therapy can effectively treat vasomotor symptoms and may reduce the risk of disease reactivation 9
• Hormone replacement therapy with estrogen is not contraindicated following hysterectomy and bilateral salpingo-oophorectomy for endometriosis 1
• Despite multiple treatment options, there is no medical therapy proven to completely eradicate endometriosis lesions 3, 2

Emerging Therapies

• Aromatase inhibitors have shown promising results in clinical trials 7
• Other innovative targets are being investigated, but most compounds have only been evaluated in pre-clinical studies or early clinical trials 7
• Antiangiogenic and immune-modulating drugs are being researched as potential nonhormonal therapies 10

Complementary Approaches

• Heat application to the abdomen or back may help reduce cramping pain 3, 2
• Acupressure on specific points may help reduce pain 3, 2
• Aromatherapy with lavender may increase satisfaction and reduce pain or anxiety 3