Although there is no known cure, a range of treatments can help manage symptoms, slow progression, and improve quality of life. These include medical, surgical, and lifestyle approaches.
Endometriosis is a long-term medical condition in which tissue similar to the lining of the uterus (called the endometrium) grows outside the womb. These cells respond to hormonal changes, causing pain, inflammation, and in some cases, infertility.
How Common Is Endometriosis?
Endometriosis affects approximately 1 in 10 women and people assigned female at birth during their reproductive years worldwide. That’s about 190 million individuals [1].
Despite its high prevalence, many remain undiagnosed for years. On average, diagnosis is delayed by up to 10 years after symptoms begin [2].
Effective treatment plays a crucial role in reducing the physical and emotional burden of the condition.
Affected Areas of the Body
Endometrial-like tissue can grow on various organs and structures, most commonly:
- Ovaries (forming endometriomas, also known as “chocolate cysts”)
- Fallopian tubes
- Outer surfaces of the uterus
- Pelvic peritoneum (lining of the abdominal cavity)
- Uterosacral ligaments (supporting the uterus)
- Bladder, bowel, and rectovaginal septum (tissue between vagina and rectum)
Less commonly, it may appear on the diaphragm, lungs, or in surgical scars.
This abnormal tissue causes scarring, adhesions (bands of fibrous tissue), and nerve irritation.
Recognising the Symptoms
Endometriosis has a broad spectrum of symptoms, which may include:
- Pelvic pain, often worsening during menstruation
- Pain during or after sexual intercourse
- Painful bowel movements or urination, especially around menstruation
- Heavy or irregular menstrual bleeding
- Chronic fatigue
- Subfertility or difficulty conceiving
Some individuals may be asymptomatic (without symptoms), especially in early stages.
What Helps Manage Endometriosis?
Treatment is individualised and depends on the severity of symptoms, patient goals (such as fertility), and stage of the condition. There is no one-size-fits-all approach.
1. Pain Relief Medication
First-line treatment usually includes non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. These reduce inflammation and alleviate pain.
Paracetamol (acetaminophen) may also be used for mild symptoms.
Pain relief does not address the underlying cause but helps improve daily functioning.
2. Hormonal Therapies
Hormone-based treatments aim to suppress the menstrual cycle and reduce endometrial tissue growth.
Common options include:
- Combined oral contraceptives (COCPs): Regulate or suppress periods
- Progestogens (e.g. norethisterone, medroxyprogesterone): Thicken cervical mucus and thin the uterine lining
- Levonorgestrel-releasing intrauterine system (LNG-IUS): A hormonal coil that reduces menstrual flow
- Gonadotropin-releasing hormone (GnRH) agonists/antagonists: Induce temporary menopause to reduce oestrogen levels
Hormonal therapies are not suitable for those trying to conceive, and side effects such as mood changes, hot flushes, or bone thinning may occur.
3. Surgical Management
Laparoscopic surgery (keyhole surgery) is used to remove or destroy visible endometrial implants. It is especially useful for:
- Severe pain not relieved by medication
- Endometriomas or ovarian cysts
- Bowel or bladder involvement
- Fertility concerns
Surgery may improve fertility and relieve symptoms but does not guarantee a permanent solution. Recurrence is possible.
In rare and severe cases, hysterectomy (removal of the uterus) may be considered, though this is typically a last resort and not a guaranteed cure.
4. Fertility Support
Endometriosis is linked to infertility in up to 30–50% of cases [3].
Assisted reproductive technologies (ART), such as in vitro fertilisation (IVF), are often recommended when natural conception is difficult.
Early referral to a fertility specialist is advised for those planning a pregnancy.
5. Diet and Lifestyle Modifications
Though evidence is still evolving, many people report improvement with the following:
- Anti-inflammatory diet (rich in omega-3s, fruits, and vegetables)
- Regular physical activity: Reduces oestrogen and inflammation
- Stress reduction through mindfulness, yoga, or counselling
- Limiting alcohol and caffeine: May reduce symptom flares
These strategies support overall well-being and may enhance the effects of medical treatments.
6. Complementary Therapies
Some individuals benefit from additional supportive therapies, including:
- Acupuncture: May relieve pain and improve circulation
- Pelvic physiotherapy: Helps with pelvic floor dysfunction and mobility
- Cognitive behavioural therapy (CBT): Assists in managing chronic pain
Always discuss complementary options with a healthcare provider to avoid harmful interactions.
Potential Complications
If untreated or poorly managed, endometriosis can result in:
- Chronic pelvic pain
- Infertility
- Adhesions and organ damage
- Bowel or urinary obstruction
- Mental health issues, such as depression or anxiety
Prompt treatment reduces these risks and helps maintain a better quality of life.
Misconceptions and Clarifications
Myth: Pregnancy cures endometriosis
Fact: Symptoms may improve temporarily during pregnancy, but the condition can return postpartum.
Myth: Hysterectomy is the only solution
Fact: It may help some with severe disease, but it’s not guaranteed to stop all symptoms.
Myth: Painful periods are normal
Fact: While mild discomfort is common, pain that interferes with daily life is not normal and should be investigated.
When to Seek Help
Speak to a GP or gynaecologist if you:
- Experience persistent pelvic pain
- Have heavy or irregular periods
- Find intercourse or bowel movements painful
- Are struggling to conceive after 6–12 months of trying
Early evaluation and diagnosis lead to better management options.
Although there is no cure for endometriosis, a combination of medical, surgical, and lifestyle treatments can significantly improve symptoms and quality of life. Treatment should be tailored to individual needs and reviewed regularly.
If you suspect you may have endometriosis, speak to a qualified healthcare provider for assessment and personalised care.
References
[1] Giudice, L.C. Endometriosis: Science and Practice.
[2] Vercellini, P., et al. Clinical Management of Endometriosis.
[3] Rizk, B., et al. Endometriosis and Infertility: A Comprehensive Guide.
