Treatment of endometriosis: can it be cured?

Currently, endometriosis is a condition with no cure. Treatment is only available to relieve symptoms that occur, such as pain and abnormal bleeding, and to control the growth of endometrial tissue. For this, a pharmacological, hormonal, natural therapy or even surgery can be applied.

This treatment should be personalized according to the age of the patient, the extent of the disease, the reproductive desire of the couple and the severity of the symptoms.

The different sections of this article have been assembled into the following table of contents.

Treatment for pain and other symptoms

The most relevant symptom that can compromise the quality of life of a woman with endometriosis is pain. To relieve it and other symptoms, there are three types of treatment:

• Use of analgesics
• Hormonal treatment
• Surgery

There is a possibility that the symptoms of endometriosis may return when medication is stopped, but medical recommendations must always be followed and treatment times must be respected.

Treatments for endometriosis symptoms

Pharmacological treatment

Analgesics may be helpful in relieving pain, but they do not work against endometriosis itself. Depending on the intensity of the pain, the doctor will prescribe one type or another of pain reliever.

The most common are nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, which reduce inflammation and relieve pain. If NSAIDs fail to control the pain, the doctor may prescribe opioid analgesics such as tramadol.

Part of the pain caused by endometriosis, especially the one associated with menstruation, comes from strong contractions of the uterine musculature. Therefore, some women with severe pain experience improvement by taking spasmolytics (muscle relaxants) such as butystoscopolamine, although its usefulness in reducing pain caused by this disease is limited.

The daily dose of all these medications should always be monitored by a doctor to avoid major side effects.

Hormonal treatment

Below we present the main hormonal options that can be used in case of endometriosis:

• Combined oral contraceptives: with them, menstruations are less abundant, more regular and shorter. It also reduces pain. It is usually used in mild endometriosis.
• Gestagens are derived from progesterone and improve symptoms by reducing or eliminating a woman's menstruation. They are available in pills, injections, subcutaneous implants, or intrauterine devices (IUDs). Dienogest and Desogestrel (oral contraceptives) and Mirena (intrauterine system) are examples of just progesterone treatments.
• Gonadotropin-releasing hormone (GnRH) agonists: prevent the production of female hormones that regulate the menstrual cycle to prevent ovulation, menstruation, and the growth of endometriosis lesions. Zoladex and Lupron are examples of injectable drugs of this type.
• Danazol: prevents the release of hormones that control the menstrual cycle. With this medication, periods disappear or only appear from time to time. It is very effective in severe endometriosis when not responding well to other treatments. While taking this treatment, it is important to avoid pregnancy, as it can harm the fetus.

The use of other hormones for the treatment of endometriosis and associated pain is being investigated. A new oral drug is gestrinone, which is currently only available in Europe.

New lines of research include drugs that reduce the amount of estrogen in the body, as they are responsible for the growth of endometriosis implants. These drugs include aromatase inhibitors, the enzyme responsible for converting androgens into estrogens but have not yet been approved for marketing and use.

Surgical treatment

Research has shown that some surgeries can significantly relieve the pain of endometriosis. Therefore, it is the best option for women with advanced endometriosis or who suffer severe pain.

In addition to removing the implants, during the procedure, the physician can locate the affected areas, examine the size and degree of growth of the implants, which allows for proper diagnosis and determination of the type of endometriosis a woman has.

The surgical alternatives are as follows:

• Laparoscopy: the abdomen is slightly inflated with a harmless gas to be able to insert and work when introducing the laparoscope, an instrument with a camera and light to be able to see the implants, and another series of surgical instruments. This removes the lesions, destroys them, and removes scar tissue. Recovery is much faster than with major surgery, such as laparoscopy.
• Laparotomy is the last resort for the treatment of endometriosis. This is a major abdominal surgery in which the implants are removed, but if the lesions are very small they may not be seen in a laparotomy. During surgery, the uterus (hysterectomy), ovaries, and Fallopian tubes may be removed in severe cases involving these organs.
• Surgery to cut the pelvic nerves: it can be removed this way if it is located in the central area of the abdomen. It can be performed both during laparoscopy and during laparotomy, either by cutting the nerves connected to the uterus or those found in the ligaments that support the uterus.

It is important for the woman to keep in mind that the operation may not be the definitive solution. After surgery, the symptoms of endometriosis may return over time. Therefore, hormone therapy may be used after surgery. In these cases, the use of Mirena is often recommended to reduce pain.

On the other hand, some of these interventions can irreversibly affect a woman's fertility, so the woman's reproductive desire must be taken into account when considering all available treatment options.

Natural treatment

Alternative treatments for endometriosis consist of a series of natural remedies. This type of therapy can help a woman relieve the symptoms of the disease. Among them we find:

• Acupuncture
• Herbal therapy
• Nutritional therapies
• Homeopathy
• Osteopathy

You can also follow some simple tips to help relieve the pain:

• Place castor oil compresses over the lower abdomen to decrease swelling.
• Kegel exercises: a series of pubococcygeal muscle contraction exercises to strengthen the pelvic muscles. This prevents symptoms such as frequent urination and bladder problems.
• Yoga, meditation, relaxation and breathing exercises to avoid stress and anxiety, which can aggravate the condition.
• Take evening primrose oil, which has anti-inflammatory properties.
• Taking valerian, which helps control menstrual spasms and relaxes muscles.
• Drink tea with raspberry leaves, which contain antioxidants that can help the immune system fight inflammation.

In more severe cases of endometriosis, natural therapies may not be enough and medical treatment may be needed.

Fertility Treatment

Endometriosis can cause fertility problems, so many women may need medical treatment to become pregnant.

If a natural pregnancy is not achieved, artificial insemination and in vitro fertilization (IVF) are the alternatives offered by assisted reproduction. For women with endometriosis, IVF is the reproductive technique that offers the best pregnancy rates.

Occasionally, the physician may consider surgical intervention prior to IVF necessary to remove endometriotic implants that affect the reproductive system and thus improve the likelihood of successful treatment.

Assisted reproduction to achieve pregnancy with endometriosis

However, it is now common to start early reproductive treatment without prior operation and, once the woman has given birth, to start treatment for endometriosis.

FAQs from users

Do women with endometriosis have poorer oocyte quality?

The answer is yes.

Endometriosis is the growth of endometrial tissue outside the uterine cavity, that is, in places where this endometrial tissue should not be.

Edometriosis can generate cysts formed by oxidized, chocolate-colored blood that are very often found in the ovaries.

In addition, the woman's body will try to defend itself against the sites where the endometrial tissue is growing inappropriately. To do so, it will activate an inflammatory response system and produce substances that are harmful to the woman's eggs.

Both situations, the chocolate cysts and the inflammatory response, will have harmful results for the eggs. And therefore the quality may decrease in women with this disease.

However, it should be noted that many cases of endometriosis are asymptomatic and women can have offspring naturally.
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What is the treatment for intestinal endometriosis?

The treatment to be followed will depend on the type of endometriosis, its extent, the severity of the symptoms, the age of the patient and her reproductive desire.

Surgery to remove the affected area of the intestine is usually successful when combined with hormonal treatment with Danazol or GnRH agonists. Otherwise, a hysterectomy may be necessary along with removal of the ovaries and tubes.

What are the criteria for endometriosis surgery?

Surgical treatment of endometriosis prior to IVF/ICSI must be individualized on a case-by-case basis. Surgical removal of an endometrioma, an ovarian cyst produced by endometrial tissue, causes a decrease in the response of the operated ovary. This results in obtaining a lower number of oocytes and embryos, often with the need for a higher dose of gonadotrophin hormones and a longer duration of stimulation.

Therefore, the recommendations of the European Society of Human Reproduction and Embryology (ESHRE) and the Royal College of Obstetricians and Gynaecologists (RCOG) are that surgery should be considered if endometriomas larger than 4 cm are present, in endometriomas that make ovarian puncture difficult, when there is a risk of rupture during ovarian puncture, or risk of recurrence of ovarian abscess, a serious complication of infection.

In case of ovarian endometriosis, what is the treatment to follow?

If endometriosis cysts appear in the ovaries, it is unlikely that they will disappear on their own and can be eliminated with drugs. Therefore, surgical intervention, either by laparoscopy or microsurgery, must be performed to remove the implants.

Is there a natural treatment that works for pelvic endometriosis?

It is possible for a woman to relieve pain and other symptoms with some natural therapy, but this will depend mainly on the degree of endometriosis and its extent. In any case, the most effective treatment for this type of endometriosis is laparoscopic surgery to remove the endometriotic implants.

Is hysterectomy the best treatment for endometriosis?

Hysterectomy is the last resort for treatment of endometriosis. It is only performed in very specific cases and in those women who have already had children and does not guarantee the elimination of pain. There are other effective treatments for pain such as natural and hormonal therapies.

Can Synarel (Nafarelin acetate) be used to treat endometriosis?

Yes, it is a common hormonal treatment prescribed to relieve the symptoms of endometriosis. It is a nasal spray which main active ingredient is Nafarelin acetate, a GnRH agonist.

Is acupuncture effective for the treatment of endometriosis?

Acupuncture helps regulate hormonal imbalances and relieve pain. According to some experts, acupuncture, accompanied by phytotherapy (medicinal plants) and dietary supplements, is very useful for treating endometriosis naturally.

Is there a special anti-endometriosis diet?

Nutrition does not have a direct effect on endometriosis, but it can help reduce symptoms and improve a woman's quality of life. A healthy and balanced diet can positively influence inflammation, pain, digestive problems or hormonal alterations.

It is recommended to lose weight in cases of obesity and, in any case, avoid foods rich in fats (especially those of animal origin) and sugars, as well as those containing caffeine and wheat. It is also advisable to avoid alcohol.

On the other hand, it is advisable to eat foods rich in fibre and phytoestrogens (vegetable oestrogens) that take care of the intestinal flora.
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Suggested readings

If you want more information on how endometriosis can affect female fertility and possible solutions, we recommend you to read this article: Endometriosis and fertility

Thus, if you are looking for more general information, you can read the following post: What Is Endometriosis? – Causes, Symptoms and Treatment

References