Endometriosis Explained — Episode 7

How Is Endometriosis Treated?

There is no single treatment that is right for every woman with endometriosis.

Treatment should be individualized according to:

• Severity and pattern of symptoms

• Desire for pregnancy now or in the future

• Age and ovarian reserve

• Extent and location of disease

• Previous treatment response

• Side-effect profile and personal preferences

1. Pain Relief

Simple analgesics and anti-inflammatory medications may help control symptoms, particularly during painful episodes.

These medications can reduce pain, but they do not treat the underlying disease itself.

2. Hormonal Treatment

For women who are not trying to conceive immediately, hormonal suppression is a major treatment option and may be used long-term for symptom control.

Options may include:

• Combined hormonal contraceptives

• Progestins

• Levonorgestrel intrauterine system

• GnRH agonists or antagonists in selected patients

• Add-back therapy when appropriate

The choice of treatment should be based on shared decision-making, because different options have different benefits, risks, side-effects, and practical considerations.

3. Give Treatment Enough Time

An important point from current guidelines is that hormonal treatment should not be labelled as a failure too early.

If side-effects are tolerable, treatment should usually be continued for at least 3 months before its effectiveness is properly assessed.

This allows enough time to evaluate whether symptoms are improving.

4. Surgery

Surgery may be considered when there is:

• Persistent or severe pain

• Organ dysfunction

• Extensive disease

• Endometrioma in selected cases

• Infertility where surgery may offer benefit

However, surgery is not automatically required simply because endometriosis is present.

The surgical plan should depend on:

• The patient’s symptoms

• Fertility goals

• Extent of disease

• Previous treatment

• Complexity of the condition

The aim is to avoid unnecessary surgery while identifying patients who are most likely to benefit from it.

5. Fertility Treatment

If pregnancy is the priority, the treatment pathway changes.

Hormonal suppression may improve pain, but it does not improve fertility in women with endometriosis-associated infertility.

Depending on the individual case, management may include:

• Fertility evaluation

• Surgery in selected patients

• Intrauterine insemination (IUI)

• In vitro fertilization (IVF)

The choice depends on factors such as:

• Age

• Ovarian reserve

• Tubal status

• Partner factors

• Previous treatment

• Severity of endometriosis

📖 Guideline Pearl

For patients who are not seeking immediate pregnancy, hormonal therapy should be offered and may be used long-term for symptom control.

Treatment should always be individualized rather than prescribed as a one-size-fits-all approach.

💜 The Key Message

The goal of endometriosis treatment is not simply to treat the lesions.

It is to treat the woman as a whole — her symptoms, fertility plans, daily functioning, and quality of life.

Dr Rabab Cares

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