The most common symptom of endometriosis is pain, with up to 80% of patients complaining of period pain and up to 50% experiencing chronic pelvic pain. Aside from the physical discomfort and day-to-day limitations that long-term, chronic pain causes, it can also massively impact a patient’s quality of life, potentially leading to psychological conditions including anxiety and depression. The anxiety can be exacerbated for those patients who experience heavy periods every month, which causes additional discomfort and worry.
The first line approach for managing the symptoms of endometriosis is painkillers. Non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen, partly function by inhibiting the production of prostaglandins. Prostaglandins cause the uterus to contract during menstruation and this contributes to the period pain experienced by patients with endometriosis. Reducing the levels of prostaglandins will reduce the painful contractions. Codeine-based medications and paracetamol-containing products are other options for pain relief.
If painkillers do not provide sufficient relief from the symptoms of endometriosis there is the option of hormonal treatment. This is not a suitable option for those who are seeking help for infertility. The endometrial deposits that develop outside the uterus, and are characteristic of the condition, form in response to the hormone oestrogen. Hormonal therapy aims to block or reduce the production of oestrogen. Frequently prescribed hormonal therapies include the combined contraceptive pill, progesterone pills and gonadotrophin releasing hormone (GnRH) analogues. The combined pill contains syntheitic versions of the hormones oestrogen and progesterone (oestradial and progestogen); it prevents ovulation and makes periods lighter and less painful. Progesterone suppresses the growth of endometrial tissue, reducing inflammation and pain. GnRH analogues block oestrogen production, causing the endometrial tissue to shrink and become inactive. These drugs place the body into a temporary menopausal state, and long term use may require further medication to combat menopause-associated symptoms, such as hot flushes and bone density loss.
Medication is just one option for the treatment of endometriosis. If symptoms persist, another option to consider is surgery. A fully personalised treatment approach is recommended for each patient, taking into account their age, symptoms, fertility status and family situation.
- Bulletti, C, et al. “Endometriosis and Infertility.” Journal of Assisted Reproduction and Genetics, vol. 27, no. 8, 25 June 2010, pp. 441–447., doi: 10.1007/s10815-010-9436-1.
- Endometriosis Treatment. Endometriosis UK, www.endometriosis-uk.org/endometriosis-treatment.
- Endometriosis. Mayo Clinic, 24 July 2018, https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661.
- Treatment: Endometriosis. NHS, www.nhs.uk/conditions/endometriosis/treatment/. Page last reviewed: 18/01/2019.