Treating Endometriosis: Medications, Surgery, Fertility, and More

Summary:

Treatment for endometriosis often includes hormone therapies like birth control pills, progestin, or GnRH agonists/antagonists. It may also include pain relief with NSAIDs, acetaminophen, or TENS. Surgeries like laparoscopy and hysterectomy may be clinically indicated in some cases. For fertility, ovulation-inducing drugs, IUI, or IVF can help patients who want to become pregnant and carry to term. Each approach comes with benefits and risks. Consulting a qualified medical provider is the best way to choose an appropriate treatment method.

Treating Endometriosis: Medications, Surgery, Fertility, and More

Getting treatment for endometriosis can be a challenge if you’re still waiting for a specialist referral. Your family doctor can sometimes help, but they may not be aware of every option available to you or feel confident educating you on them without an official diagnosis or input from a gynecologist.

This can make it difficult to learn about potentially appropriate treatment options until later in your endometriosis journey, but CanSAGE is here to help. Below, you’ll find a balanced overview of the main treatment options for endometriosis, including how they work, their possible downsides, and the benefits they can provide.

Download the Endometriosis Treatment Options Handout

Want a clear, easy-to-scan summary of the info on this page? CanSAGE’s free Endometriosis Treatment Options Handout is free to access and simple to use:

• Click the button below to download the PDF file
• Save it for quick access on your phone, tablet, or computer
• Print it off to bring to your doctor’s appointment
• Use it as a reference when comparing treatment options

Download the Endometriosis Treatment Options Handout

Hormone Therapies

Hormone therapies are often  a first-line treatment for endometriosis as they’re often highly effective for addressing symptoms. Many health care providers are familiar with them because they’re used for multiple indications. Common forms include pills, injection, implant, or Intrauterine Devices (IUDs).

Combination Birth Control

Combination birth control typically contains a low dose of both estrogen and progesterone. They work by suppressing ovulating and thinning the uterine lining. Endometriosis lesions may  respond to these changes in a similar way, so they become less active over time.

Common names	Generic: varies by formulation Brand: Yaz, Tri-Cyclen, NuvaRing, Evra LoLo
Common side effects	Nausea Breast tenderness Headaches Higher blood pressure Spotting or breakthrough bleeding (especially at first)
Risks	Carries a 0.1% risk of blood clots, including DVTs ~0.001% risk of heart attack or stroke.  Risks increase with age, dose, and if you smoke.
Benefits	Lighter and shorter periods Less cramping and pelvic pain May reduce or improve acne 99% effective for contraception with proper use Reduces ovarian and endometrial cancer risk by 40–50%.

Progestin-Only Therapies

These medications contain only a progestin/progesterone, which can help thin the uterine lining over time and reduce bleeding more effectively. They don’t change estrogen levels in the body, but counteract the effect it has on lesions instead.

Common names	Generic: Norethindrone Acetate, Dienogest, Medroxyprogesterone, Levonorgestrel Brand: Depo-Provera (injection), Mirena (IUD), Camila (pill)
Common side effects	Irregular bleeding or cycles Mood changes Weight gain Higher blood pressure Low blood sugar (hypoglycemia)
Risks	Depo-Provera can cause 0.5-3.5% bone density loss in year 1 Slightly increases breast cancer risk (2.0% to 2.2%) Fertility can take up to 18 months to return after you stop with injections,  rapid return to normal ovulation/fertility with IUD and oral pills
Benefits	May be an option for patients who cannot take estrogen Greatly reduces heavy bleeding and pain No need to take a daily pill for contraception Helps to reduce heavy bleeding ~55% of Depo-Provera users stop having periods after 1 year Useful for preventing recurrences after surgery

Alternative Medications

Medications like these aren’t as commonly prescribed for endometriosis, but they can be helpful for some patients when other treatments are not effective. Like most hormone therapies, they work by blocking the effect estrogen has on lesions.

Common names	Generic: Danazol (an androgen similar to testosterone), Letrozole (an aromatase inhibitor that stops androgens from converting to estrogen) Brand: Danocrine, Femara
Side effects	Danazol: acne, weight gain, unwanted hair growth Letrozole: bone loss, hot flashes, other menopause-like symptoms
Risks	Long-term Danazol can cause liver damage Danazol lowers HDL (“good” cholesterol) by about 11.6% Lower HDL levels can increase heart disease risk Letrozole may cause 2–3% bone loss per year Can sometimes cause rashes or red, peeling skin
Benefits	Sometimes used when first-line treatments fail Patients often do well on a low dose Vaginal Danazol further reduces systemic effects Reduces pelvic pain and pain during sex Vaginal delivery helps curb heavy bleeding

Non-Hormonal Therapies

GnRH Agonists and Antagonists

GnRH medications are a nonhormonal way to decrease the amount of circulating estrogen in the body by suppressing the ovaries slightly to fully (this is similar to menopause). Less circulating estrogen means less stimulation or fuelling of endometriosis lesions. 

At full suppression, “addback” medications may be used to reintroduce small amounts of estrogen and progesterone. This can help prevent symptoms of low estrogen, like hot flashes, sleep disturbances, and mood changes without stimulating endometriosis.  

Common names	Generic: Leuprolide, Goserelin, Nafarelin (agonists); Elagolix, Relugolix (antagonists) Brand: Lupron, Zoladex, Synarel, Orilissa, Myfembree
Side effects	Hot flashes and night sweats Vaginal dryness Headaches Mood changes Decreased sex drive
Risks	Some patients need to take “add-back” estrogen Without the use of concurrent addback therapy, GnRH agonists like leuprolide may cause 0.56–3% bone density loss Lost bone density may or may not return after stopping if no addback is used
Benefits	May work when other treatments fail Myfembree reduces pelvic and period pain in ~75% of patients Useful for preventing recurrences after surgery May be used in assisted reproductive therapy, such as IVF, to achieve the best outcome possible in pregnancy

Pain Management Strategies

Medications and strategies in this category can be used to address pain either as a starting point or alongside other treatments. Depending on your treatment plan, they can complement hormonal or non-hormonal therapies and go beyond self-care approaches, like meditation, exercise, and diet.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Non-steroidal anti-inflammatory drugs (NSAIDs) work by blocking prostaglandins, hormone-like chemicals in the body that cause inflammation and pain. They’re more effective than acetaminophen for pelvic pain.

Common names	Generic: Ibuprofen, Naproxen, Diclofenac Brand: Advil, Aleve, Voltaren
Side effects	Stomach upset Heartburn Nausea Dizziness High blood pressure
Risks	Long-term use increases gastrointestinal bleeding risk by 2–4% Associated with cardiovascular events such as heart attack Diclofenac and ibuprofen carry a higher heart risk than naproxen Should be used with caution in people kidney disease
Benefits	Easy to access and affordable Can be taken as needed or around the clock short-term Proven to reduce pelvic and period pain

Acetaminophen (Paracetamol / Tylenol)

Acetaminophen works by blocking pain signals, but unlike NSAIDs, it doesn’t reduce inflammation. It’s very safe when used correctly and can be combined with NSAIDs or taken on its own.

About Acetaminophen (Paracetamol / Tylenol)

Common names	Generic: Acetaminophen Brand: Tylenol
Side effects	Stomach upset Nausea Red rash or peeling skin Constipation
Risks	Exceeding the dose can cause liver damage or failure Risk of liver injury is much higher if you consume alcohol Check OTC products carefully to avoid accidental overdose May cause thrombocytopenia, leucopenia, neutropenia (~0.01%)
Benefits	Safe, well tolerated, and effective Useful for mild, periodic pain during flares or menstrual cycles Much lower risk of stomach upset and ulcers compared to NSAIDs

TENS Machines

A transcutaneous electrical nerve stimulation (TENS) device treats pain by sending a gentle electrical pulse into the nerves. This blocks pain signals and tells your muscles to relax.

Common names	Generic: TENS machine Many options available
Side effects	Mild skin irritation under electrodes Tingling or buzzing sensations Takes time to work in some patients
Risks	Allergic reactions to the glue on electrodes Not safe for people with pacemakers, epilepsy, or numbness Not recommended in pregnancy or around malignant growths
Benefits	Best non-drug option for endometriosis pain at home Can be used at home, at work, or even on the go Very safe compared to other treatment options

Surgical Options

Surgery may be used to confirm a clinical diagnosis of endometriosis or to remove lesions (i.e.- excise)  when other treatments don’t provide sufficient relief. A well-timed, well-executed surgery can be very effective particularly for those patients with deep or severe disease. These surgeries can be complex and require expertise given the higher risks associated.

Read More: Resection of Superficial Endometriosis: 3 Laparoscopic Techniques

Laparoscopic Excision

Surgeons remove visible lesions and scar tissue by passing camera-guided tools through small incisions on the abdomen. This is the most minimally-invasive surgical option for treating endometriosis.

Common names	Generic: Laparoscopy, minimally-invasive surgery
Risks	Risks of any laparoscopic surgery include:  Anaesthesia-related side effects such as nausea/vomiting Bleeding (needing a transfusion is exceedingly rare), Infection at the small incision Urinary tract infection or pelvic infections depending on the extent of your surgery Injury to the bowel, bladder, ureters or nerves There is also a small risk for new adhesions: This is due to the inflammatory nature of endometriosis The risk is significantly less than if the surgery were to be performed through a large incision (laparotomy)
Benefits	Best option for confirmation of diagnosis with the ability to excise and treat at the same time (see and treat surgery) May Improves pain, quality of life, and fertility in appropriate cases Rapid return to activities and work

Hysterectomy

Hysterectomy is the removal of the uterus. This can be part of a definitive surgery for endometriosis if your fertility journey is complete or not desired. Patients often see a significant improvement in quality of life with this option if they have endometriosis or adenomyosis. Any endometriosis lesions are typically removed (excised) at the same time. A minimally invasive approach is preferred.

Common names	Generic: Hysterectomy
Risks	Infection in the bladder, uterus, abdomen Damage to the ureters, bladder, uterus, or bowel Hemorrhage, sometimes requiring blood transfusion Anaesthesia-related side effects such as nausea/vomiting  Slightly increased risk of blood clots (0.4%–0.7%) Adhesions develop in about 60–90% of patients
Benefits	Up to 76% of patients experience at least some pain relief May improve bladder, bowel, or organ-related problems Completely stops periods, which may be preferred Eliminates heavy bleeding, clots, and other period symptoms

Fertility and Assisted Reproductive Technologies (ART)

Endometriosis may be associated with infertility. Your specialist might refer you to a fertility clinic so you can discuss the options available to you. Ovulation induction helps the ovaries release eggs, while in-vitro fertilization (IVF) bypasses the fallopian tubes and transfers embryos created in a lab into the uterus. 

Surgery can sometimes play a role in the success of fertility treatments, but this should start with a clear discussion between you, the fertility clinic, and your surgeon.

Learn More: Endometriosis and Fertility: What You Need to Know

Taking Charge of Your Endometriosis Care

Endometriosis doesn’t have to control your life. Hormone therapies, OTC pain relievers, and the other options on this list can help you advocate for a treatment plan that fits your needs and goals. It’s always best to navigate this path with the help of a specialist who understands endometriosis, but if your family doctor is your only option for now, you can always print out this handout and bring it in.

For more endometriosis resources, visit CanSAGE’s videos page.