Everyone’s experience of endo is different; what works for some may not work as well for others. What’s important is to get the help that’s right for your body and your life.
Endometriosis can be managed with specialized surgery, medication, and medical care from different specialist doctors and allied healthcare providers. Holistic approaches, like how you eat, manage stress, and process difficult emotions can also help. The choice of treatment will depend on your goals, preferences, and your situation. For example, some treatments are best for deep endo, while others might not be the best route if you plan to have a child in the future. It’s your body, your life, and you get to choose your treatment plan. It is important to have a conversation with your doctor about the benefits and risks of the many management options that may be available to you.
Surgical management
Endometriosis can be treated through laparoscopic surgery. This is a type of minimally invasive surgery where the surgeon makes incisions– small cuts– in the abdomen. The surgeon uses the incisions to insert a tiny camera and surgical instruments into the pelvis. The camera works like a magnifying glass, so that the surgeon can see and operate on the endometriosis more easily. Laparoscopic surgery is preferred over other forms of surgery for endometriosis because it is less painful and has a faster recovery.
The goal of laparoscopic surgery for endometriosis is to remove endometriosis growths and scar tissue that can prevent your organs from functioning normally. The benefits, risks, and limitations of surgery depend on each individual case of endometriosis. Discuss your options with your surgeon to learn what’s best for you and your life.
Gynecologists need specialized training and expertise to do excision surgery for endometriosis. Not all gynecologists perform excision surgery. See our directory of endometriosis surgeons in Canada.
Sometimes, pain comes back months or years after endometriosis surgery. This can happen because of new endometriosis growth, or because of other conditions that cause pelvic pain, for example adenomyosis or pelvic floor dysfunction. The chance of endometriosis coming back after surgery depends on where the endometriosis was located and the type of surgery you had. Endometriosis is much more likely to come back after ablation surgery than excision surgery. Endometriosis on the ovaries is more likely to come back than endometriosis in other locations in the body. Endometriosis on the bowel or bladder is not likely to come back if it is fully treated with excision surgery. In some cases, taking medications for endometriosis may decrease the need for more surgeries. It’s important to talk to your surgeon to figure out the best treatment plan for your specific situation.
Medical management
Medication options can be used to treat the symptoms of endometriosis. Symptoms usually come back when you stop taking the medication.
For some people with endometriosis, anti-inflammatory medications like ibuprofen (Advil) or naproxen (Aleve) can be helpful for painful periods, but for others, there is no meaningful pain relief. These medications are usually not effective for other types of endometriosis pain.
Other medications used to manage the symptoms of endometriosis include those that affect the body’s hormones and control or stop the menstrual cycle. The goal is to have fewer periods, or stop having periods altogether, to ease or stop the endo pain a person has during their period. Many of these options also stop ovulation, which can be useful for people with painful ovulation. Medication options for endometriosis vary in how effective they are in managing symptoms. Research shows that they work about 60-80% of the time to improve symptoms.
Medication options for endometriosis include:
- Combined hormonal contraception (“the birth control pill”) taken continuously without any breaks for a period, or with 2-3 periods per year
- Progestin-only pills like norethindrone or dienogest (Visanne)
- Progestin-secreting intrauterine systems (IUSs) like the levonorgestrel intrauterine system (Mirena, Kyleena, and others)
- Gonadotropin-releasing hormone agonists like leuprolide acetate (Lupron) or goserelin (Zoladex)
- Gonadotropin-releasing hormone antagonists like elagolix (Orilissa)
- Aromatase inhibitors like letrozole (Femara) and anastrazole (Arimidex)
Medical care from different specialist doctors and allied healthcare providers
Many people with endometriosis benefit from other types of medical care not provided by gynecologists. These can include:
- Pelvic health physiotherapy: an effective treatment for some symptoms of endometriosis, like pain with sexual activity. It can also help treat other conditions and diseases that many people with endometriosis have, either as a result of endometriosis or in addition to it.
- Mental health support: people with endometriosis often deal with mental health symptoms like depression and anxiety. Getting counselling or therapy can help improve mental health.
- Chronic pain care. For people who have chronic pelvic pain in addition to endometriosis, specialized chronic pain clinics offer different treatment options and holistic care.
Complementary and alternative medicine
People with endometriosis often try Complementary and Alternative Medicine (CAM) alongside traditional medical approaches. CAM refers to approaches people use to take care of their health that are different from the usual medicines and treatments. Considering these approaches may be especially helpful if you are waiting to see a specialist or waiting to have surgery.
CAM options used by people with endometriosis can include:
- Acupuncture
- Cannabis
- Diet/nutrition
- Exercise
- Heat
- Meditation / breathing / relaxation practices
Find expert help for endometriosis
Here is a directory of endometriosis surgeons practising in Canada.
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Surgery: A Guide for People With Endometriosis
There are different types of surgery you may undergo as part of the treatment of your endometriosis. Understand how to find the right surgeon, plan your endometriosis surgery, and what to expect in the months and years after surgery so you can choose the surgery that will work best for you.
