Endometriosis Treatment: Medication and Hormonal Therapy for This Chronic Condition

In women with endometriosis, portions of the uterine lining grow outside the uterus. They can also grow onto other organs. This can cause severe pain during menstruation and even infertility. 

It is estimated that between 2% and 30% of all women are affected by endometriosis. The peak incidence occurs during childbearing years, between the ages of 35 and 45. 

In general, endometriosis is characterized by nonspecific pain and a variety of other nonspecific symptoms. These symptoms are caused by endometrial cells that grow into tissues and organs, where they continue to be influenced by the hormone estrogen. Their activity therefore follows the woman’s menstrual cycle.

The so-called primary symptoms include, above all,

• menstrual cramps (dysmenorrhea),
• problems with urination, and
• pain during or after sexual intercourse.

In endometriosis, the uterine lining grows outside the uterus © Henrie

In addition, the following nonspecific symptoms may occur:

• lower abdominal pain (especially during menstruation),
• bladder dysfunction,
• bowel problems,
• Nausea and even vomiting,
• headaches and dizziness,
• back pain,
• flank pain,
• hot flashes,
• fatigue, and
• frequent infections.

In addition, affected patients may become infertile. In most cases, the journey to fulfilling the desire to have children is a long one.

There is usually a gap of about 6 to 10 years between the diagnosis of “endometriosis” and the possible onset of symptoms. 

If endometriosis is suspected, patients should ideally visit a specialized center for endometriosis treatment. In addition to a physical examination, a diagnosis is primarily made there using specialized diagnostic methods. These include, among others:

• a physical examination, including a gynecological exam, a digital rectal exam, and inspection of any scars,
• transvaginal ultrasound,
• magnetic resonance imaging (MRI), if necessary,
• ultrasound of the bladder and kidneys,
• surgical hysteroscopy and histological biopsy.

Both conservative and surgical treatments are available for endometriosis.

However, it is important to note that, despite available treatment options, the disease is currently incurable. The underlying cause of endometriosis is unknown. Therefore, there is currently no causal treatment.

Endometriosis should always be treated at a specialized center using an interdisciplinary approach.

Hormonal Treatment Options

Hormonal therapy for endometriosis aims to inhibit the growth of tissue outside the uterus by lowering estrogen levels. This alleviates pain and allows for a reduction in pain medication.

Progestins (e.g., through the use of the birth control pill or a hormonal IUD) are frequently used to suppress the menstrual cycle. GnRH agonists are a more potent form of hormone therapy, but they are associated with more side effects; they significantly lower estrogen levels and can trigger symptoms similar to those of menopause. 

Medication for Endometriosis

There is currently no effective medication for endometriosis; treatment is limited to alleviating symptoms.

Pain management is the simplest form of pharmacological therapy.

• Analgesics,
• dietary supplements, such as maritime pine bark extract, or
• physical therapies (relaxation techniques, heat therapy, physical therapy)

are intended to provide relief from painful, monthly symptoms during menstruation.

Surgical Treatment of Endometriosis

In some cases, it may also be necessary to treat patients surgically. Indications for surgery include:

• symptoms that persist despite treatment,
• women with suspicious-looking changes in the ovaries, or
• patients who wish to become pregnant despite a diagnosis of endometriosis.

The areas of inflammation are usually treated using minimally invasive (laparoscopic) surgery. Laparoscopy allows the surgeon to examine the abdominal cavity using an endoscope without having to make a large incision. In addition, the surgeon can remove the endometriosis lesions using tiny instruments during the procedure.

The advantage of minimally invasive surgical treatment is the small incision. This means faster wound healing and a quicker return to mobility after surgery. There is also less pain following the procedure, and any resulting surgical scar is smaller.

However, this procedure requires greater technical expertise.

The chances of success with surgical treatment for endometriosis are good in many cases. Patients wishing to have children have also become pregnant naturally after the procedure. However, neither surgical treatment nor hormonal therapy leads to a long-term cure for endometriosis.

The recurrence rate following surgical or hormonal therapy ranges from 20% to 80%. As a rule, doctors will always first consider medical treatment for endometriosis before performing another surgery in the event of a recurrence.

An improvement in the condition and its associated symptoms is possible after menopause. During this time, a woman’s hormonal balance changes, and the hormone-dependent endometriosis cells become less active.

Doctors specializing in endometriosis treatment work in specialized endometriosis centers. In particular, gynecologists treat endometriosis.

Due to the nature of the condition, other organs may be affected, which is why an interdisciplinary approach also involves specialists in

• surgery,
• pathology,
• urology,
• radiology, and
• reproductive medicine

may be involved.

In addition, other non-medical professionals are often involved, such as

• pain management specialists,
• physical therapists,
• nutritionists, or
• psychotherapists.

Since public and medical awareness of the condition has been relatively low to date, and in order to strengthen research, collaboration, and care, the German Society for Gynecology and Obstetrics (DGGG) founded the Endometriosis Working Group (AGEM). It promotes scientific findings, the ongoing continuing education of physicians, and the transfer of knowledge into clinical practice with the goal of speeding up diagnosis, improving treatment, and raising awareness of the disease.