Treatment of Endometriosis
Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus. It causes chronic pelvic pain, especially during menstruation, and can lead to infertility. It affects approximately 10% of reproductive-age women.
Managing Endometriosis effectively requires a combination of medical treatment, lifestyle modification, and regular monitoring. With a structured management plan, most people with Endometriosis can maintain a good quality of life and prevent serious complications.
First-Line Treatment Principles
- ✓Identify underlying cause: hormonal, structural, tubal, male factor, or unexplained
- ✓Lifestyle optimisation before fertility treatment: weight, smoking, folic acid
- ✓Ovulation induction with clomifene or gonadotrophins for anovulatory infertility
- ✓IVF/ICSI when other approaches have failed or irreversible causes (tubal occlusion, severe male factor)
- ✓HRT for menopausal symptoms: lowest effective dose for shortest duration
What to Do Now
- Learn your personal risk factors for Endometriosis (family history, age, lifestyle)
- Attend regular health check-ups and screening tests appropriate for your age and risk
- Track new or changing symptoms, especially those associated with Endometriosis
- Use our AI symptom checker to assess whether your symptoms fit an early Endometriosis pattern
- Discuss preventive strategies and early monitoring with your GP
- Build a personalised management plan with your GP or specialist
- Adhere consistently to prescribed medications — do not stop without medical advice
- Adopt a Endometriosis-appropriate diet (anti-inflammatory, low-glycaemic, or disease-specific)
Medications Used in Endometriosis
Ethinylestradiol is a hormonal agent used for contraception, hormone replacement therapy, or the management of menstrual and gynecological disorders.
Levonorgestrel is a hormonal agent used for contraception, hormone replacement therapy, or the management of menstrual and gynecological disorders.
Norethisterone is a hormonal agent used for contraception, hormone replacement therapy, or the management of menstrual and gynecological disorders.
Desogestrel is a hormonal agent used for contraception, hormone replacement therapy, or the management of menstrual and gynecological disorders.
Drospirenone is a hormonal agent used for contraception, hormone replacement therapy, or the management of menstrual and gynecological disorders.
Medroxyprogesterone is a hormonal agent used for contraception, hormone replacement therapy, or the management of menstrual and gynecological disorders.
Progesterone is a hormonal agent used for contraception, hormone replacement therapy, or the management of menstrual and gynecological disorders.
Tibolone is a hormonal agent used for contraception, hormone replacement therapy, or the management of menstrual and gynecological disorders.
Non-Pharmacological Management
- •Weight management: BMI 18.5–25 kg/m² optimises conception rates and reduces obstetric complications
- •Folic acid 400mcg/day: before conception and for 12 weeks in pregnancy (5mg in high-risk)
- •Smoking cessation and alcohol avoidance: improve fertility and reduce miscarriage
- •Regular exercise: moderate-intensity; avoid extreme exercise that suppresses ovulation
- •Stress reduction and psychological support during fertility treatment
- •Pelvic floor physiotherapy: for pelvic pain, prolapse, and urinary incontinence
Treatment Goals
Monitoring Parameters
- ◆Day 21 progesterone: confirm ovulation
- ◆AMH (anti-Müllerian hormone) and antral follicle count: ovarian reserve assessment
- ◆Semen analysis: concentration, motility, morphology — both partners assessed
- ◆Transvaginal ultrasound: follicle monitoring during stimulation cycles
- ◆Endometrial thickness: before embryo transfer (>7mm adequate)
- ◆HCG levels: early pregnancy monitoring; doubling every 48h confirms viable implantation
Red Flags — When to Escalate
- ⚠Any of the characteristic symptoms of Endometriosis — even mild — in a high-risk individual
- ⚠Progressive worsening of early warning signs over weeks
- ⚠Laboratory abnormalities (e.g., blood sugar, inflammatory markers) without full symptoms
- ⚠Unexplained weight loss, night sweats, or fatigue persisting >2 weeks
- ⚠Strong family history of Endometriosis combined with new relevant symptoms
- ⚠Sudden worsening of Endometriosis symptoms despite established treatment
Escalation Criteria
- →Ovarian hyperstimulation syndrome (OHSS): freeze-all embryos if severe; hospitalisation if critical
- →Ectopic pregnancy: urgent surgical or medical (methotrexate) management
- →Recurrent pregnancy loss (≥3): full investigation panel; specialist reproductive medicine referral
- →Endometriosis not responding to medical therapy → laparoscopic surgery consideration
Special Populations
Clinical Insights
Compare With Similar Conditions
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