Endometriosis occurs when the lining of the uterus, or endometrium, spreads to other places such as the Fallopian tubes, ovaries or other parts of the pelvis, according to Mayo Clinic. Just as it would inside the uterus, this tissue bleeds every month during the menstrual cycle. But when it's in the wrong place, this blood becomes trapped and irritates surrounding tissue causing scarring, cysts, bleeding, pelvic pain and fertility problems.
Pain Medications
Treatment for endometriosis varies depending on the severity of the symptoms, the patient's desire to get pregnant and any complications, according to the Mayo Clinic. Doctors typically start with the most conservative approach, which often means using over-the-counter pain medication such as ibuprofen or naproxen to ease pelvic pain and cramping. If over-the-counter options don't work, doctors may prescribe stronger pain medication. These drugs ease pain but don't treat any other symptoms of endometriosis, according to the American Congress of Obstetricians and Gynecologists or ACOG.
Hormone Therapy
If pain killers don't work, the next step is usually hormone therapy, according to the Mayo Clinic. Hormone therapy works by interfering with the normal menstrual cycle that causes displaced endometrial tissue to bleed. Birth control pills,patches or rings can cause lighter periods or halt menstruations completely and reduce symptoms.They can control endometriosis while a woman takes them, but the problem returns when she stops. Gonadotropin-releasing hormone agonists also block menstruation and stave off endometriosis for months or years after treatment. But they can cause an artificial menopause with side effects such as hot flashes and vaginal dryness that must be treated with low-dose estrogen. Progestin can block periods and shrink endometriosis, but it can cause irregular vaginal bleeding as well as mood and weight changes and sexual problems, according to ACOG. Danazol not only blocks menstruation, it can also directly suppresses the monthly growth of the endometrial tissue. It's often not a first choice because side effects include acne, weight gain and facial hair.
Conservative Surgery
Conservative surgery removes the stray endometrial tissue from where it doesn't belong, along with any growths or scar tissue causing problems, according to the Mayo Clinic. It's usually done with a small incision in a minimally invasive way, but it can also be done in an open surgery if necessary. The surgeon can use a laser, surgical instruments or heat to remove stray tissue while leaving the reproductive organs intact. Symptoms return within one year for about half the women who undergo conservative surgery, according to ACOG.
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Hysterectomy
In truly severe cases, a complete hysterectomy--in which the full uterus is removed--usually cures endometriosis and prevents it from returning, according to ACOG. Removing the ovaries as well makes it more likely that the endometriosis will not return. There is a small risk that symptoms will recur. The procedure causes early menopause and destroys a woman's chance of getting pregnant.
