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Remember, the information on my website, podcast, Instagram, and any other ways I communicate and/or produce content is educational information only and not medical advice. Always check with your qualified medical professional before making any changes to your treatment plan for endometriosis or any other health problems. See my full disclaimer here.

Non-Surgical Management Options

This page talks about nonsurgical management options for endometriosis. Also see my page on surgical treatment options and specifically on hormonal suppression.

The treatment recommendations a person receives for endometriosis typically depends on the doctor’s skills, experience, and knowledge, so when looking for an endometriosis specialist, it’s important to understand endometriosis and know about the different treatments so you can make an informed decision on your care.

Endometriosis treatment and management needs an individualized approach

Endometriosis is not a homogeneous disease: it has different forms, can be in different locations, can have different biological activity, and cause different symptoms from one patient to the next. Patients also may have different co-conditions and other pain/symptom generators that need addressing.

Treatment* also depends on patient goals, accessibility, and tolerability. 

*Treatment and management – Most options available to patients are not treating the disease, but are attempting to manage the symptoms of endo.

For example, some general questions to assess your situation might be:

  • What role does fertility play for you? Are you dealing with infertility?

  • Do you want to have surgery? Do you have medical conditions that prevent surgical care? Is surgery accessible to you in terms of location/cost, etc?

  • What have you already tried? What has helped and hasn’t?

  • What kinds of side effects/consequences do the treatment options have? For example: X hormonal suppression helped symptoms but had intolerable side effects that made it impossible to stay on. Diet changes helped, but triggered disordered eating.

  • Have your symptoms worsened over time?

Some specific goals that patients have are:

  • to get pregnant
  • to have a form of birth control
  • to improve their quality of life
  • to have less urinary urgency
  • to have less pain
  • to improve their symptoms enough to hold a job
  • to not have periods anymore because of heavy flow and clotting
  • to remove a large endometrioma
  • to restore anatomy, such as organs stuck together or a frozen pelvis
  • to remove endometriosis that may lead to serious organ dysfunction, such as intestinal or ureteral lesions

There is no one right treatment or management option for everyone. Since endometriosis is a chronic, full body illness, many people find that to improve quality of life, this often includes addressing their diet, lifestyle, sleep, pelvic floor, hormonal health, gut health, mental health, thought patterns, and more. For some people, one or a combo of these may be enough to improve symptoms. Others take hormonal suppression. Others find they don’t have sustained relief until they have excision surgery (often in combo with these other full body factors). It’s truly individual.

How we treat or manage our endo may change over time as well, depending on what we can access, if our symptoms worsen or improve, if our goals change, if we get new co-conditions, and other factors.

Pain Management

In 2018, the UK’s National Health Service named endometriosis in a list of twenty of the most painful conditions a person can get. Getting pain relief is vital from this illness that can cause chronic pain and/or excruciating pain that makes us writhe and vomit. 

Work with your doctor for pain relief. There are different types of pain medications, both over the counter or prescription (note that the names of these will differ by country):

  • non-opoids: Tylenol, Midol, Paracetamol, etc
  • opioids: vicodin, tramadol, codeine, morphine, etc
  • compound painkillers: there are a mix of two types of painkillers
  • non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, aleve, naproxen, advil
  • gabapentin (Neurontin), pregabalin (Lyrica) 
  • low dose natrazone

Some of these are better for chronic pain, some better for flares or acute pain situations. It’s often recommended that patients try to “beat the pain”. For example, if someone knows their period is agonizing, they may want to start taking NSAIDs the day before the pain comes.

I think that many people with endometriosis find that NSAIDS, in particular naproxen, helps reduce their pain, because these can block prostaglandin production (and prostagladins can play a role in endometriosis pain). However, these can also cause digestive upset and/or gastritis or ulcers, especially with long term use.

Some other things that may help pain are:

  • Pelvic floor therapy
  • CBD oil
  • High dose fish oils
  • Chinese herbs
  • Acupuncture
  • Diet change, such as cutting out trigger foods or following an individualized anti-inflammatory diet
  • Meditation
  • Pain reprocessing therapy
  • TENS machine
  • Heat, such as heating pads
  • Foam rolling
  • Exercise
  • etc

Everyone is going to find that these or some combination of these works differently for them. There are different types of pain and different places we may have pain. Foam rolling, for example, may help with leg pain. A TENS machine, for example, may help with period pain. Diet change, for example, may help with inflammatory pain. For some people, one or more of these may eliminate pain. For others, it might diminish it to more tolerable levels. For others, none of these may seem to help.

Diet, Lifestyle, Supplements, etc

Diet, lifestyle, herbs, supplements, yoga, turmeric, celery juice, finding self-love, etc don’t remove, reverse, dissolve or cure endometriosis lesions, in spite of the many claims on the internet. However, any combination of these may help some people with their symptoms or overall quality of life (but it varies per person). It’s important to know that:

  • Endometriosis can still progress on any diet/lifestyle – even if we are pain free.

  • Pain going away doesn’t mean our endometriosis went away. This distinction is crucial.

See Endo is a Full Body Disease for ideas on a multidisciplinary approach to reduce inflammation, symptoms, and pain.

Pregnancy

Pregnancy is not a treatment for endometriosis. If a doctor recommends that you “just get pregnant”, it is definitely a red flag that your doctor is not knowledgeable about endometriosis.

For More Info

  • Treatment – From Nancy’s Nook, which is an incredible “endometriosis learning library.” This is the first article in their Treatment section, so make sure to check out the rest too!

  • Pain Medications – From Nancy’s Nook