Endometriosis Treatment: What Are My Options?

Endometriosis treatment is not one-size-fits-all; what works brilliantly for one woman may not suit another, and finding the right approach can sometimes involve a little trial and error. For some women, painful periods are the biggest problem. For others, it may be persistent pelvic pain, pain during sex, bowel symptoms or difficulty becoming pregnant. Your age, fertility plans, previous treatments and how you feel about hormonal medication or surgery will all influence the choices you make.

Importantly, treatment should be guided by how endometriosis is affecting you, rather than simply by how much disease appears on a scan. NICE recommends basing treatment on a woman’s symptoms, preferences and priorities rather than the stage of endometriosis.

In this post, I plan to talk you through the some of the treatment options for endometriosis – from pain relief and hormonal treatments, to surgery and the wider approaches that may help manage symptoms day to day.

Is there a cure for endometriosis?

At present, there is no treatment that can guarantee endometriosis will disappear permanently. Treatment aims to manage pain and reduce other associated symptoms, thereby improving quality of life whilst taking fertility plans into account. I think this highlights why management needs to be individualised to each patient. Someone trying to become pregnant will have very different priorities from someone whose main aim is to stop painful periods!

If you are still wondering whether your symptoms could be caused by endometriosis, you may want to begin with my guide to endometriosis symptoms and diagnosis.

Do I have to have surgery for endometriosis?

No.

You do not necessarily need a laparoscopy and surgical confirmation of endometriosis before treatment can begin. It is often reasonable to treat suspected endometriosis from the symptoms and clinical picture while investigations or referrals are taking place.

Surgery can be extremely helpful for some women, but it is not automatically the best first treatment for everyone. The options may include pain relief, hormonal treatment, surgery or a combination of approaches, depending on your symptoms, fertility plans and preferences. The Royal College of Obstetricians and Gynaecologists provides a helpful overview.

Pain relief options for endometriosis

Simple pain relief is often the first place to start and anti-inflammatory medicines such as ibuprofen can be particularly helpful for period-related pain because they reduce the production of prostaglandins — chemicals involved in inflammation and uterine cramping. Paracetamol may also help, and often a combined approach is needed. I always think that Paracetamol is a wonderful drug for amplifying the effects of other drug treatments.

One practical point is that anti-inflammatory medication often works better when taken early, rather than waiting until the pain has become severe – it is far easier to prevent then it is to overcome pain. NICE suggests considering a short trial of paracetamol or a non-steroidal anti-inflammatory drug, alone or in combination, for first-line management of endometriosis-related pain.

There are a variety of anti-inflammatory medications available and if Ibuprofen does not work, then another – such as Diclofenac or Mefenamic Acid may work better. I should be clear that these medicines are not suitable for everyone, particularly those with certain stomach, kidney or asthma problems, so check with your doctor or pharmacist if you are unsure.

If you regularly need significant amounts of pain relief simply to get through your periods, I would also want to look at why the pain is happening, rather than repeatedly treating it without further assessment.

Why are hormones used to treat endometriosis?

Endometriosis is affected by hormones, particularly oestrogen. Hormonal treatments work by reducing or stopping periods and limiting the hormonal stimulation of endometriosis. For many women, this can make a real difference to their pain. The aim is not necessarily to find the “strongest” hormonal treatment. It is to find something that controls your symptoms while providing an acceptable balance between benefits and side effects.

Hormonal treatment does not permanently damage future fertility, but most hormonal treatments prevent pregnancy while they are being used. They are therefore not appropriate when you are actively trying to conceive. NICE recommends offering hormonal treatment such as the combined pill or a progestogen for suspected, confirmed or recurrent endometriosis.

Can the combined pill help endometriosis?

Yes it can!

The combined contraceptive pill is commonly used to manage endometriosis symptoms. The contraceptive patch or vaginal ring can often be used in a similar way if preferred. Rather than having a monthly withdrawal bleed though, combined hormonal contraception may be used continuously, without the usual hormone-free break. For someone whose symptoms flare every time she menstruates, reducing the number of bleeds — or stopping them altogether — can make a considerable difference.

Did you know that you do not medically need a monthly withdrawal bleed while taking combined hormonal contraception?

However it is important to remember that combined hormonal contraception is not suitable for everybody; your medical history and cardiovascular and thrombotic risk factors must be considered.

What about progestogen treatments?

Progestogens are another important option, particularly when oestrogen-containing contraception is unsuitable or not wanted.

Depending on the individual, options available include a progestogen-only pill, contraceptive implant, injection or a 52 mg levonorgestrel intrauterine system, such as Mirena. These treatments work in slightly different ways but broadly aim to reduce hormonal stimulation of endometriosis. They frequently make periods lighter and may stop them altogether.

*It is important to point out that the hormone-free or ‘copper’ coil is very different to the IUS or Mirena and should be avoided in heavy, painful periods as it will make things much worse*.

Side effects vary between preparations and individuals. They may include irregular bleeding, breast tenderness, headaches, acne or changes in mood. There is no one progestogen that is universally “best”. Sometimes finding the right treatment means trying one option, reviewing how your body responds and changing course if it does not suit you.

Can the Mirena coil help endometriosis?

Yes.

The Mirena, or 52 mg levonorgestrel intrauterine system, can be very useful for some women. It works by releasing progestogen directly into the womb and commonly makes periods much lighter; for some women, bleeding stops completely. This can be particularly helpful when painful or heavy periods are a significant part of the problem.

Not everyone wants or can tolerate an intrauterine device, however, and it is not automatically the right choice simply because someone has endometriosis.

What is dienogest?

Dienogest is a progestogen specifically licensed for the treatment of endometriosis.

Unlike many of the contraceptive progestogens used to manage endometriosis symptoms, dienogest 2 mg has been licensed specifically for this condition. It is taken as one tablet every day, continuously and without a break. It reduces the body’s production of oestradiol and acts on endometrial tissue, helping to reduce endometriosis-related pain.

Dienogest may be considered when more conventional hormonal treatments have not worked or have caused unacceptable side effects. Local NHS prescribing arrangements vary, and it is often started by a gynaecologist or specialist service.

Changes in bleeding are common, particularly during the first few months. Other possible side effects include headache, breast discomfort, acne, reduced libido and changes in mood. Oestrogen levels are moderately reduced, so bone health also deserves consideration in anyone with particular risk factors for osteoporosis.

Importantly, although dienogest suppresses ovulation in most women, dienogest 2 mg is not licensed as a contraceptive. If contraception is required, its product information advises using a non-hormonal method during treatment. Further prescribing information is available in the dienogest Summary of Product Characteristics.

What happens if the pill or a progestogen does not work?

There are other hormonal treatments available when first-line options have not controlled symptoms or have not been tolerated. These include medicines that act on the gonadotrophin-releasing hormone, or GnRH, pathway.

Traditional GnRH agonists are given as long-acting injections, usually every month or every three months. Goserelin is given as a small implant placed under the skin of the abdomen. Treatment is generally limited to around six months because it temporarily suppresses ovarian hormone production, creating a reversible menopause-like state. This can help relieve endometriosis pain but may cause hot flushes, vaginal dryness, disturbed sleep and loss of bone density. Low-dose add-back hormone treatment is therefore often prescribed to reduce these symptoms and help protect bone health.

What are the newer oral GnRH antagonists?

Newer oral GnRH antagonists suppress the same hormonal pathway, but work more directly than traditional GnRH agonists. They do not cause the initial hormonal “flare” associated with GnRH agonists and, because they are tablets with a relatively rapid and reversible effect, treatment can be adjusted or stopped more easily than a long-acting injection.

NICE now recommends two oral GnRH-antagonist options for adults of reproductive age who have already had medical or surgical treatment for endometriosis:

• relugolix–estradiol–norethisterone acetate combination therapy
• linzagolix with hormonal add-back therapy.

Relugolix combination therapy was recommended by NICE in April 2025, followed by linzagolix with hormonal add-back therapy in June 2025. Both can be used routinely within the NHS in England when they are considered the most suitable treatment within their licensed indications.

Clinical trials found that both treatments reduced painful periods and non-menstrual pelvic pain compared with placebo. Indirect comparisons suggest pain relief may be broadly similar to treatment with a GnRH agonist, although neither medicine has been directly compared in trials with the full range of treatments used in UK practice. There is also uncertainty about how their outcomes compare with surgery. The add-back hormones provide a small amount of oestrogen and progestogen to reduce menopausal symptoms and limit bone loss while the GnRH antagonist suppresses ovarian hormone production.

These medicines provide valuable additional choices, particularly for women whose symptoms have not responded to other treatment. However, they are not generally first-line treatments, like all treatment options for endometriosis, their suitability requires individual assessment, including contraindications to the add-back hormones, bone health, other medicines and pregnancy plans.

What about surgery for endometriosis?

Surgery can be helpful when symptoms remain troublesome despite medical treatment, an ovarian endometrioma is present, deep endometriosis is suspected or fertility is a concern. Most endometriosis surgery is performed by laparoscopy, or keyhole surgery. Depending on what is found and what has been agreed beforehand, the surgeon may treat visible endometriosis and adhesions during the operation.

Surgery for deep endometriosis, particularly disease involving the bowel, bladder or ureters, can be considerably more complex. NICE recommends assessment and management through a specialist endometriosis service with access to the appropriate multidisciplinary team.

There is a great deal more to understand about surgery, including excision versus ablation, treatment of ovarian endometriomas, possible effects on ovarian reserve, recurrence and when hysterectomy may be considered.

I will therefore cover the surgical treatment of endometriosis properly in a separate article.

Does a hysterectomy cure endometriosis?

Not necessarily, a hysterectomy removes the uterus, but endometriosis is, by definition, found outside the uterus. Removing the womb therefore does not automatically remove all endometriosis.

For some women with particular symptoms or another condition such as adenomyosis, hysterectomy may form part of a surgical treatment plan. If hysterectomy is undertaken, NICE recommends excising all visible endometriotic lesions at the same operation where possible.

Hysterectomy remains a major and irreversible decision and should not be presented as a guaranteed cure. The possible benefits and risks of retaining or removing the ovaries, recurrence, possible further surgery and the implications for future hormone replacement therapy all need careful discussion.

What if I want to become pregnant?

This changes the conversation considerably.

Most hormonal treatments used to suppress endometriosis prevent pregnancy while you are taking them, so they are not appropriate when you are actively trying to conceive and NICE specifically advises that hormonal treatment does not improve spontaneous pregnancy rates in women trying to conceive.

Management may instead involve assessing other fertility factors, whether there are endometriomas or significant pelvic disease, whether surgery may help and whether referral to a fertility specialist is appropriate. However, many women with endometriosis can conceive naturally, so a diagnosis does not automatically mean that IVF will be required. Nevertheless, fertility plans should be discussed early rather than treated as an afterthought.

Can pelvic-health physiotherapy help?

Depending on the prevailing symptoms, for some women, yes. Long-standing pelvic pain can lead to the pelvic-floor muscles becoming tense and overactive. This can contribute to pelvic aching, pain during sex and sometimes bowel or bladder symptoms.

Pelvic-health physiotherapy can assess whether this is contributing and may use techniques aimed at relaxing and retraining the pelvic floor. This does not mean that the pain is “muscular rather than endometriosis”. Several mechanisms can contribute to pain at the same time.

For women who have lived with pelvic pain for years, treating the whole pain picture may be much more helpful than focusing solely on visible endometriosis lesions.

Can diet help endometriosis?

There is a great deal of information online about the “best” diet for endometriosis, often expressed with more certainty than the evidence allows.

Some women do notice that particular foods influence bloating, bowel symptoms or general wellbeing. If so, it is reasonable to explore this, ideally while keeping a symptom diary so that any pattern is clearer.

A nutritious Mediterranean-style pattern — including vegetables, fruit, whole grains, pulses, nuts, fish and unsaturated fats — is a sensible foundation for overall health. However, there is no good evidence that a particular diet, supplement or detox can cure endometriosis.

Endometriosis can also coexist with IBS and other gastrointestinal conditions. My article about the relationship between oestrogen and gut symptoms provides some further background on the ways hormonal changes can affect the bowel.

Remember, restrictive diets are not harmless. If you are removing several food groups, losing weight unintentionally or already have nutritional deficiencies or a difficult relationship with food, I would involve a suitably qualified dietitian.

What about exercise, heat and other ways of managing pain?

Sometimes simple measures can genuinely help. A hot-water bottle or heat pad can be very useful for cramping. Gentle movement, walking, stretching, yoga or whichever form of exercise feels manageable may help some women, even though the research cannot currently identify one particular exercise programme as an endometriosis treatment.

Sleep, stress and emotional wellbeing matter too — not because stress causes endometriosis, but because living with persistent pain is exhausting.

Chronic pain can affect sleep, mood, relationships, sex, work and confidence. Those effects deserve care and support in their own right. Depending on the individual, management may include a specialist pain service, pelvic physiotherapy and psychological support alongside treatment directed at the endometriosis.

Do supplements help endometriosis?

There is considerable interest in omega-3, magnesium, vitamin D, curcumin and various antioxidant preparations, but at present, the evidence is not strong enough to say that any particular supplement treats endometriosis. NICE specifically states that the available evidence does not support Chinese herbal medicines or supplements as endometriosis treatments.

That does not mean nutrition is irrelevant. If you have iron deficiency because of heavy bleeding, for example, identifying and correcting that deficiency is important. But treating a nutritional deficiency is different from taking a supplement marketed as a treatment for endometriosis. And I should also point out that “Natural” does not automatically mean effective, and it does not automatically mean risk-free.

Can GLP-1 medicines help endometriosis?

There is growing interest in whether medicines such as semaglutide, liraglutide or tirzepatide might influence endometriosis.

The theory is biologically interesting. GLP-1-based treatments can improve insulin resistance, reduce body weight and influence inflammatory and metabolic pathways. One small human study found lower levels of naturally occurring GLP-1 in the peritoneal fluid of women with endometriosis, alongside differences in immune-cell markers. However, this does not establish that prescribing a GLP-1 medicine treats endometriosis. You can read the underlying study in the International Journal of Molecular Sciences.

At present, there is no good evidence from randomised clinical trials that GLP-1 therapy reduces endometriosis lesions, reliably relieves endometriosis-related pain, prevents progression or improves fertility specifically in women with endometriosis.

A woman with endometriosis may, of course, have a separate indication for GLP-1 treatment, such as obesity or type 2 diabetes. Improving weight and metabolic health may benefit mobility, general wellbeing and operative risk in some women, but this is different from treating endometriosis itself. GLP-1 medicines can cause side effects and symptoms; they can commonly cause nausea, bloating, constipation, diarrhoea and abdominal discomfort. These side effects can overlap with gastrointestinal symptoms already attributed to endometriosis.

For now, GLP-1 therapy is best regarded as an interesting area for future research, but not an established treatment for endometriosis.

Could weight loss and GLP-1 treatment reduce gynaecological cancer risk?

Maintaining a healthier weight may have benefits beyond improving metabolic health. Excess body fat is associated with several cancers, but the strongest gynaecological link is with endometrial cancer.

Adipose tissue affects oestrogen production, insulin resistance and inflammation. After menopause, it becomes an important source of circulating oestrogen through the conversion of androgens to oestrogens. Hyperinsulinaemia, reduced sex hormone-binding globulin and chronic inflammation may also promote endometrial proliferation.

The World Cancer Research Fund considers the evidence that greater body fatness increases endometrial cancer risk to be convincing. The association with ovarian cancer is considered probable, while the relationship with cervical cancer is much less certain.

It is therefore biologically plausible that substantial, sustained weight loss could reduce endometrial cancer risk. Research into intentional weight loss supports this direction of effect: a systematic review found substantially lower rates of endometrial cancer following bariatric surgery, although these observational findings cannot simply be transferred to medication-induced weight loss. (Systematic review and meta-analysis)

Emerging research is also looking specifically at GLP-1 medicines. A large retrospective study published in 2025 found that GLP-1 use in adults with overweight or obesity was associated with lower recorded rates of endometrial and ovarian cancer. However, it was an observational study and cannot prove that the medicines prevented those cancers. The absolute differences were small, the estimates for individual cancers were imprecise and longer follow-up is needed. (Dai and colleagues, JAMA Oncology, 2025)

The possible benefit may reflect weight loss, improved insulin sensitivity and reduced inflammation. Direct effects on tumour biology are also being investigated, but remain unproven.

GLP-1 therapy should not currently be prescribed specifically to prevent gynaecological cancer. Nevertheless, when a woman has an established indication for weight-management treatment, reducing obesity is likely to improve her wider long-term health and may reduce her risk of endometrial cancer in particular.

What if treatment is not working?

Go back and review the plan. If one pill, one coil or one operation has not helped, it does not mean that nothing else can be done. Endometriosis treatment is a journey and not a one size fits all situation.

Sometimes the diagnosis needs revisiting. Sometimes a different hormonal approach is worth trying. Specialist imaging or surgical assessment may be appropriate, and several factors may be contributing to pelvic pain at the same time.

NICE recommends referral for further gynaecological assessment when initial treatment is ineffective, not tolerated or contraindicated; symptoms have a detrimental impact on daily life; or symptoms remain persistent or recurrent. Suspected or confirmed endometriomas, deep endometriosis or disease outside the pelvis warrant referral to a specialist endometriosis service.

The important message

There is no single best treatment for endometriosis.

For one woman, taking the combined pill continuously may give excellent symptom control. Another may do better with a progestogen, Mirena or dienogest. Someone else may benefit from an oral GnRH antagonist or surgery, while another may need hormonal treatment alongside pelvic physiotherapy and support for chronic pain.

Your priorities may also change. The treatment that suits you in your twenties may not be the treatment you want when you are trying to conceive — or later in life when contraception is no longer important.

The aim should be to find a plan that makes your life better, rather than simply treating a scan result.

If you are still at the stage of wondering whether your symptoms could be endometriosis, start with my guide to endometriosis symptoms and diagnosis. I have also written separately about the new saliva test for endometriosis and how Endotest works.

I will look more closely at surgery for endometriosis in the next article, including the different surgical approaches, when surgery may help and the questions worth asking before deciding whether it is right for you.

Reliable further information

• NICE: Endometriosis — diagnosis and management
• RCOG: Endometriosis patient information
• ESHRE guideline on endometriosis
• NICE: Relugolix–estradiol–norethisterone for endometriosis
• NICE: Linzagolix for endometriosis

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This article is intended for general information and education. It cannot replace an individual medical assessment, diagnosis or treatment.

Dr Hannah Murphy MBBS MRCGP DFSRH
Private GP & Women’s Health Doctor
Doghurst Clinic