Endometriosis treatment and living with it

There is no known cure for endometriosis; treatment aims to reduce pain and symptoms and, when needed, to support the chance of pregnancy. According to guidelines, options include painkillers, hormone medication and surgery. Which one suits you is decided with your doctor, based on your symptoms, age, wish to conceive and preferences. The information below is a general summary, not personal advice.

What treatment options are there?

The 2022 ESHRE guideline recommends shared decision-making between doctor and patient. It lists these options:

Option	How the guideline treats it
Painkillers (NSAIDs and similar)	May be offered alone or together with other treatments to reduce pain
Hormone treatments (combined hormonal contraceptives, progestogens, intrauterine system, GnRH agonists and antagonists)	Recommended to be offered as one of the options to reduce pain. GnRH drugs are generally considered second line because of their side-effect profile
Aromatase inhibitors	Considered for pain that does not respond to other treatments
Surgery	Recommended to be offered as one of the options to reduce pain

Hormone medication can prevent pregnancy. The plan is different for people who want to conceive; see endometriosis and pregnancy.

When does surgery come into play?

Surgery can remove (excision) or burn (ablation) the lesions. According to ESHRE, people with deep endometriosis should be referred to an experienced centre and informed of the risks, benefits and long-term effects of surgery on quality of life. Removing the uterus (hysterectomy) may be considered in some people, but the guideline asks that people are told it may not necessarily cure the disease or the symptoms.

Can it come back after treatment?

Yes. The 2022 ESHRE guideline mentions data suggesting a recurrence rate of 20% to 50% within five years, irrespective of the treatment approach, although it is unclear whether this means recurrence of symptoms or of disease. That is why treatment planning is usually long-term and personal. The frequency and type of follow-up should be individualised.

What can help in daily life?

The evidence here is limited, and honesty matters: ESHRE cannot recommend any single method such as nutrition, exercise, physiotherapy or acupuncture to reduce pain, because potential benefits and harms are unclear. The World Endometriosis Society consensus says many people report that lifestyle approaches help their quality of life, but few well-designed studies exist, and there is no evidence that weight loss reduces symptoms.

Still, ESHRE recommends that clinicians discuss non-medical strategies for quality of life and emotional wellbeing. Practical things that make sense:

• Keeping a pain and symptom diary makes it easier to talk to your doctor.
• Telling your doctor about methods you find soothing and safe.
• Planning daily tasks around fatigue and pain.
• Seeking support from support groups and people you trust.

Mental health and support

Chronic pain and years of not being taken seriously are exhausting. ESHRE recommends considering psychological support for people with a diagnosis. For more, see our article on endometriosis and mental health.

A next step

Before discussing treatment options, you can use the symptom checklist to organise your symptoms.