The medical approach to endometriosis is usually to treat using stages of severity to determine the treatment plan. Endometriosis is classified (American Society for Reproductive Medicine) as stage I (minimal), stage II (mild), stage III (moderate), or stage IV (severe). These stages are determined by the location, depth and number of endometrial ‘implants’, and if there are any adhesions present.
Medical treatment options for endometriosis
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate discomfort
- Ovarian-function blocking drugs to reduce oestrogen output
- Surgical removal or laser ablation of implants and/or endometrium
- Surgery and drugs
- Oral contraceptives
- Hysterectomy with removal of ovaries and fallopian tubes (salpingo-oophorectomy), usually only if childbearing is complete and endometriosis is severe
Treatment usually results in recurrence, so any treatments are considered largely symptom management.
Different endometriosis treatment drugs and what they do
There are a few different types of drugs used to treat endometriosis, and they all function in a slightly different way. NSAIDs are often used first as symptom relief until further treatments can be determined and tests carried out to see the extent of the problem.
Drugs can suppress ovarian function and therefore slow or inhibit the growth of endometrial implants. These drugs include the oral contraceptive pill (most often used), gonadotrophin-releasing hormone agonists (GnRH agonists), Danazol (Danocrine). These treatments may cause a pregnancy-like state, reduce bleeding and flow, or suppress oestrogen production.
Oral contraceptive pills reduce menstrual flow and stabilise oestrogen. Danazol and other progestogens create a pseudo-pregnancy state, as does the pill with long-term use. GnRH agonists create a temporary menopausal state by suppressing oestrogen production, but can only be used for six months or less due to loss of bone density with extended use.
Mifepristone – an abortion drug (RU486) – has been trialled, as have aromatase inhibitors. Aromatase is an enzyme that converts testosterone to oestrogen in fat cells. Aromatase inhibitors leave the testosterone intact, reducing circulating oestrogens.
Deciding which medical treatment best suits a woman will depend on personal circumstances and medical history, how severe the endometriosis is, and whether she wants to become pregnant or not. Drug tolerance is also a factor.
Surgery is usually on the cards when there are many endometriomas, blockage of the fallopian tubes, pelvic adhesions, and severe pain. The decision to undergo surgery may be influenced by a woman’s desire to become pregnant. Most surgery involves laser or surgical removal of the implants and adhesions, but keep reproductive organs intact and thus preserve fertility.
Laser laparoscopic surgery to treat pain has an excellent success rate – in one study regarding endometriosis pain, 62.5 per cent of women had complete or partial reductions in pain, without complications. Laser ablation for mild endometriosis isn’t always a fertility improver.
Severe pain may be treated surgically in other ways, however the specifics of your treatment will be determined in person by your practitioner.
Naturopathic approaches to endometriosis
The point of natural therapy treatment in endometriosis will vary from woman to woman, and is often used in conjunction with medical treatments. A natural therapist will look to normalise hormone levels and reduce oestrogen excess, reduce pain and inflammation, and optimise immune function. Treating the uterus for both function and menstrual flow may be important elements of treatment. Fertility may be of paramount importance outside of pain management and reducing recurrence rates.
Period pain – dysmenorrhoea: treatments apply equally for period pain caused by endometriosis as for other types of period pain. (See treatments for period pain – secondary dysmenorrhoea – here)
Heavy bleeding – menorrhagia: treatments for heavy menstrual bleeding are addressed on the menorrhagia page. (See treatments for menorrhagia here)
Premenstrual syndrome (PMS): PMS may need a bit more investigation than period pain or heavy bleeding, but treatments for all three are likely to be combined into one overarching treatment by your naturopath to manage your hormones and other elements that contribute to negative premenstrual symptoms. (See more on PMS treatments here)
Diet can play a role in managing endometriosis via hormone management. (Learn more about the role of diet in oestrogen levels and endometriosis here)
Regulating hormones in endometriosis
Because endometriosis is an oestrogen-dependent condition, managing relative oestrogen excess and hormones generally is a large part of treatment. Naturopathically treating relative oestrogen excess involves looking at all facets of oestrogen production and maintenance of oestrogen levels, and looking at inflammatory process that is exacerbated by incorrectly placed endometrium.
Important elements of managing endometriosis include clearance of hormones via the liver and bowel, and implementing other oestrogen-clearance practices such as exercise and diet. Increasing relative progesterone levels is also an important element. A key factor in managing endometriosis is not to lower oestrogen abnormally, but to balance hormones so the body functions optimally – that is, increasing progesterone and reducing excess oestrogen circulation.
Your endometriosis-experienced naturopath will be able to offer you personalised treatment strategies and can work in conjunction with your doctor where applicable.