What Is the Best Medication Option for Endometriosis?

Combined hormonal contraceptives (birth control pills), containing ethinyl estradiol (an estrogen) and progestins (synthetic progesterones), are commonly used as a first-line therapy for endometriosis.

Progestin-only pills are considered a second-line treatment and may be helpful for people who aren’t good candidates for estrogen-containing treatment or who did not respond to combined hormonal therapy.

About 70% of women using progestins report satisfaction with the treatment.

Another second-line option includes gonadotropin-releasing hormone (GnRH) agonists and antagonists, which are also effective ways of managing the hormones that affect endometriosis. However, these medications can have side effects and limitations on how long they can be used.

GnRH antagonists like relugolix and linzagolix are currently under evaluation, often in combination with low dose estrogen-progestin.

Surgery may be needed for severe cases of endometriosis.

What is the first-line medication for endometriosis?

Combined hormonal contraceptives, commonly in the form of birth control pills containing both ethinyl estradiol and progestins, are often prescribed as a first-line treatment for endometriosis.

While there’s no cure for endometriosis, medical treatment can effectively reduce painful symptoms, improving overall quality of life.

Medication for endometriosis can help:

• relieve pain
• reduce menstrual symptoms, such as cramps and discomfort
• regulate the menstrual cycle
• improve emotional well-being due to pain relief
• improve sleep

How does medication for endometriosis work?

Hormonal contraceptives work in the following ways:

• Shrink endometrial tissue: The medications aim to reduce the size of the endometrial tissue and prevent it from growing. With endometriosis, this tissue can grow outside the uterus, causing pain.
• Manage menstrual bleeding: Many people with endometriosis experience painful menses, so by managing or eliminating menstrual bleeding, the symptoms associated with endometriosis can improve.
• Prevent ovulation: Ovulation is the release of an egg from the ovary. By preventing ovulation, these medications aim to reduce the hormonal changes that contribute to endometriosis.
• Anti-inflammatory effects: Endometriosis involves inflammation, and these medications have properties that can help reduce inflammation, which is a source of pain.
• Cell-death-promoting effects: Endometrial tissue growing outside the uterus may be targeted for cell death (apoptosis) by these medications, helping to manage its growth.

GnRH agonists work by temporarily increasing hormones and then downregulating GnRH receptors to cause lower estrogen levels (hypoestrogenic state). They also suppress ovarian estrogen production, creating a temporary menopausal state.

On the other hand, GnRH antagonists work by blocking GnRH effects to rapidly suppress estrogen without an initial surge. They also create a temporary menopausal state, reducing menstrual pain.

Treatment options for endometriosis include:

• Combined birth control pills: Regulating hormones with birth control pills containing ethinylestradiol (an estrogen) and progestins (synthetic progesterone) may alleviate symptoms.
• Progestin-only pill: This is a contraceptive pill that contains only progestin.
• Hormonal IUD: This intrauterine device (IUD) releases hormones to reduce pain and bleeding.
• GnRH agonists: These drugs induce a temporary menopause-like state to relieve symptoms.
• Depot medroxyprogesterone acetate: This is an injection that inhibits ovulation.
• Laparoscopy: This is a minimally invasive surgery to remove endometrial tissue.
• Laparotomy: In severe cases, this type of open abdominal surgery may be needed.
• Hysterectomy: In very severe cases, removal of the uterus may be recommended.
• Over-the-counter pain relievers: Ibuprofen or prescription medications can help manage pain.

Is there a cure for endometriosis?

While there are various treatment options available to manage symptoms, such as medications, hormonal therapy, and surgery, these approaches are often aimed at relieving pain and improving quality of life rather than providing a definitive cure.

Lifestyle changes and alternative therapies may help address inflammation, pain, and stress.

Lifestyle changes

• Dietary modifications: Some individuals find relief by avoiding certain foods, such as those with trans fat and gluten.
• Exercise: Some evidence suggests that exercise may help relieve endometriosis-related pain, but more high quality studies are needed.
• Stress management: Techniques like yoga or meditation may provide relief. A 2022 study found that a brief mindfulness-based intervention significantly improved pelvic pain and dyschezia (difficulty passing stool) immediately after treatment. Mental health and vitality scores also improved in the follow-up period.

Alternative therapies

• Acupuncture: Acupuncture may reduce endometriosis-related pain. A 2017 review of 10 studies involving 589 participants showed that acupuncture significantly reduced pain compared with the control groups. Positive effects on peripheral blood CA-125 levels, a marker associated with endometriosis, were also observed in the acupuncture group.
• Herbal supplements: While research is limited, some herbs may offer relief for endometriosis. Lavender, chamomile, and ashwagandha are a few herbs that may help.

Endometriosis is a chronic condition where tissue similar to the uterine lining grows outside the uterus. While there isn’t currently a cure, medications like hormonal contraceptives, progestins, and GnRH agonists can manage symptoms by reducing inflammation, preventing ovulation, and targeting endometrial tissue growing outside the uterus.

Alternative treatments, including lifestyle changes and mind-body interventions, may also offer additional relief. If you’re experiencing symptoms, consult a healthcare professional to explore suitable treatment options.