Medications to Treat Endometriosis: What Are the Current Options?

Endometriosis is a common cause of painful periods, pelvic pain, and infertility. There’s no cure for endometriosis. But there are effective treatment options that offer endometriosis pain relief. Newer medications are more effective than ever.

Below, we take a look at the current options for endometriosis medications.

What is endometriosis?

Endometriosis develops when tissue that normally grows inside the uterus starts growing on other parts of the body. Most of the time, the tissue grows on organs that are also inside the pelvis. But studies show that the endometrium can start growing on any organ of the body, even the brain.

The most common areas that the endometrium attaches to are:

• Bladder

• Ovaries

• Fallopian tubes

• Bowels

• Kidney

• Abdominal scars (like C-section scars)

Endometriosis causes pelvic pain, painful intercourse, and heavy menstrual bleeding. Some people also experience trouble going to the bathroom. Symptoms can range from moderate to severe. Most people experience some level of pain and discomfort. Some experience debilitating symptoms that keep them from completing their usual activities.

Quiz: Do I have endometriosis?

What causes endometriosis?

It’s not clear why some people develop endometriosis. Researchers believe several factors are involved, including hormones, the immune system, and genetics.

Some theories on how endometriosis develops include:

• Retrograde menstruation: Developed in the 1920s, this theory states that endometriosis is a result of retrograde menstrual flow. This is when menstrual blood flows backward from the uterus into the fallopian tubes and then out into the pelvic cavity. The blood carries endometrial tissue with it. This tissue lands on other organs, sticks, and starts to grow. Retrograde menstruation is quite common. Studies show about 90% of menstruating women have retrograde menstruation. But not all of them develop endometriosis. This has led researchers to investigate other factors that result in endometriosis.

• Cell transformation: With the help of proteins, cells on other organs can transform into endometrial cells. This theory may explain why males can also be affected with endometriosis. It also can explain why women born without a uterus can also develop endometriosis.

• Immune system mismatch: The immune system can usually recognize when tissue is somewhere it shouldn’t be. But in some people, the immune system doesn’t recognize when endometrial tissue grows outside the uterus. This allows the tissue to grow unchecked, which causes endometriosis.

• Genetics: Endometriosis runs in families. The exact genetics of endometriosis aren’t fully understood yet. But it’s clear that if others in your family have endometriosis, you are at a higher risk of developing symptoms.

Are there medicines you can take for endometriosis?

Yes. There’s no cure for endometriosis. But there are several effective treatments for endometriosis that can help relieve symptoms.

Endometrial tissue grows in response to hormone levels. Many endometriosis medications target these hormones and reduce their levels. Other endometriosis medications target pain pathways to provide endometriosis pain relief.

Here are six classes of medication that can treat endometriosis.

Nonsteroidal anti-inflammatory medications (NSAIDs)

Ibuprofen (Motrin) and naproxen (Naprosyn) are nonhormonal medications that can relieve endometriosis pain. It’s not clear if NSAIDs work for everyone.

These medications aren’t good options if you have a history of gastric ulcers or kidney problems. You also shouldn’t take these medications if you are pregnant.

Combined estrogen-progestin contraceptives

Combined estrogen and progestin hormonal contraceptives are first-line therapy for  endometriosis. These medicines help limit your periods so that endometrial cells don’t have a chance to grow. This also reduces inflammation from endometriosis. The result is lighter periods and less pain.

Options include birth control pills, utilizing a patch, or the vaginal ring. If you have a history of blood clots or can’t take estrogen, these options may not be right for you.

Progestin  

Taking progestin by itself can also provide pain relief from endometriosis. Progestins can decrease the amount of endometrial tissue in the body.

Progestins are available as a pill or an injection. Options include:

• Norethindrone acetate (Aygestin)

• Medroxyprogesterone acetate (Provera)

• Dienogest (Visanne)

Progestins may be a good option if you have a history of blood clots or are at high risk for developing blood clots.

Gonadotropin-releasing hormone (GnRH) agonists

GnRH agonists are medications that reduce the amount of estrogen in the body. Estrogen controls endometrial tissue growth. So, having less estrogen means you’ll also have less endometrial tissue. That, in turn, means lighter periods and less pain.

GnRH agonists are available as nasal sprays or injectable medications. Common options are:

• Leuprolide acetate (Lupron)

• Goserelin (Zoladex)

• Nafarelin (Synarel)

GnRH agonists are offered to people who don’t respond to estrogen-progestin options. A major drawback to GnRH agonists is that they can lower estrogen too much. This causes side effects like bone loss, vaginal dryness, and hot flashes.

GnRH antagonists

GnRH antagonists also lower estrogen levels in the body. But they don’t lower estrogen levels as much as the GnRH agonists. This lets people avoid side effects from low estrogen levels.

GnRH antagonists used to treat endometriosis include:

• Elagolix (Orilissa)

• Relugolix, estradiol, and norethindrone acetate (Myfembree)

Do endometriosis treatments improve fertility?

No. Endometriosis medications won’t improve fertility.

If you are having trouble getting pregnant, there are treatment options available. These treatment options include assisted reproductive techniques such as in-vitro fertilization. Endometriosis laparoscopic surgery may improve fertility for some people. Its success rate varies, so it’s not a good option for everyone.

The best option depends on your individual situation. A reproductive endocrinologist can help you decide on the best care plan.

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Written by:

Jennifer Clements, MD, MSEd, NBHWC

Jennifer Clements, MD, MSEd, NBHWC, is a board-certified physician and health coach who is passionate about achieving optimal health through healthy lifestyles. Clements is a diplomate of the American Board of Obesity Medicine and the American Board of Integrative Medicine.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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