If symptoms are very mild or if the menopause is approaching, an expectant management may be suitable. Alternatively treatment with pain-killers (analgesics e.g. mefenamic acid) may be recommended.

Medical treatment

This consists of different types of hormone treatments and is aimed at relieving symptoms in particular those of pain. Often these drugs may:

  • bring about an improvement in the pain symptoms
  • shrink or slow down the progression of the condition
  • delay the recurrence of the disease
  • hormonal treatments may have some side effects

Commonly used drugs include:

  • progestogens
  • GnRH analogues
  • combined oral contraceptive pill
  • Mirena intra-uterine system (IUS)
  • Depo-provera injection

Gonadotrophin Releasing Hormone (GnRH) Analogues (Gonapeptyl, Prostap or Zoladex)

These hormones (GnRHa) temporarily switch off the ovaries and virtually remove the production of oestrogen production. This results in a temporary but reversible menopause. This tends to cause shrinkage of endometriosis, as it is known to be oestrogen dependant. Lack of periods and shrinkage of endometriosis with these drugs tend to give an improvement of the symptoms. However, the condition tends to come back after the treatment is discontinued.

GnRHa may be used prior to surgery to shrink and reduce vascularity of endometriosis to facilitate surgery. They are sometimes used after or instead of surgery in selected patients.

These drugs are usually given for two to six months and most women feel better during treatment. Sometimes drugs may be used for longer, but in such situations additional hormone replacement therapy is given to prevent osteoporosis and menopausal symptoms

What are the main side effects?

Some women experience no side effects. Others may experience some of the following symptoms:

  • hot flushes
  • decreased sex drive (libido)
  • mood changes
  • breast changes
  • insomnia

These side effects generally reduce within a few weeks of completing treatment. With longer use osteoporosis may also occur

Severe adhesions secondary to pelvic endometriosis