What are the treatment options for endometriosis?

From the Guidelines

Treatment options for endometriosis include both medication and surgical approaches, with the goal of alleviating symptoms and improving quality of life, as recommended by the World Endometriosis Society consensus on the classification of endometriosis 1. The mainstay of treatment for endometriosis includes:

• 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, which 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), which create a temporary menopause-like state to reduce estrogen levels, though these typically require add-back hormone therapy to prevent bone loss if used beyond 6-12 months For severe cases or when fertility is desired, laparoscopic surgery to remove endometrial implants and adhesions may be necessary. The treatment approach should be individualized based on symptom severity, fertility desires, side effect profiles, and patient preferences, as endometriosis is a chronic condition requiring ongoing management. Key considerations in managing endometriosis include:
• The use of classification systems, such as the revised American Society for Reproductive Medicine (r-ASRM) classification, the Enzian classification for deep endometriosis, and the endometriosis fertility index (EFI), to guide treatment decisions and predict outcomes
• The importance of standardizing methods for ascertaining symptoms, undertaking examination, and performing laparoscopic surgery to improve the accuracy of diagnosis and treatment
• The need for ongoing research and development of new classification systems and treatment approaches to improve the management of endometriosis and reduce the burden of suffering for affected women.

From the Research

Treatment Options for Endometriosis

The treatment options for endometriosis can be categorized into medical, surgical, and expectant management.

• Medical management focuses on symptom improvement and includes:
  • Gonadotropin-releasing hormone (GnRH) agonists and antagonists 2, 3, 4
  • Oral contraceptives and progestogens 2, 3, 4
  • Aromatase inhibitors (AIs) 2, 3, 5, 4
  • Non-steroidal anti-inflammatory drugs (NSAIDs) 4
• Surgical management involves the excision of endometriosis and is preferred over ablation or fulguration of endometriotic lesions 6
• Expectant management may be considered in some cases, where the patient's symptoms are monitored and treatment is initiated if necessary 6

Medical Treatment

Medical treatment for endometriosis aims to halt the growth and activity of endometriosis lesions.

• The primary goal of medical treatment is to improve symptoms and quality of life 3, 6
• Medical treatment options should be chosen based on efficacy, patient preference, incidence and severity of adverse effects, and cost 2
• Long-term or repeated courses of medication may be required to control symptoms 3

Emerging Therapies

New therapies are being investigated for the treatment of endometriosis, including:

• Gonadotropin-releasing hormone antagonists 2, 4
• Aromatase inhibitors 5
• Progesterone antagonists and selective progesterone receptor modulators 3
• Intrauterine releasing systems with progestin 3
• Pharmaceutical agents affecting inflammation, angiogenesis, and matrix metalloproteinase activity 3