Medical Management

Evidence-based guidance to relieve endometriosis pain with medical therapy—hormonal and non‑hormonal options, sequencing with or after surgery, side‑effect and safety considerations (including recurrence), and tailored care from diagnosis to menopause.

Overview

Medical management focuses on relieving endometriosis pain and abnormal bleeding by suppressing ovarian hormones, calming inflammation, and modulating pain pathways. Medicines can substantially reduce symptoms and lower recurrence risk after surgery, but they do not remove lesions. Plans are tailored to goals such as pain control, bleeding regulation, fertility timing, and life stage, including adenomyosis overlap. Options like the levonorgestrel IUD for longer term symptom control and short course GnRH analogs as part of assisted reproduction may be helpful.

Guidance covers how to choose among continuous combined oral contraceptives, progestogen-only options (oral, injectable, or IUD), GnRH agonists and antagonists with add‑back therapy, and select off‑label choices such as aromatase inhibitors for refractory disease. Non‑hormonal pain medicines and neuromodulators are part of the available options. At-Home Remedies and integrative therapies overlap and nerve‑specific strategies are addressed in Nerve Pain. Learn when medication is preferred, how it can be sequenced with or after Surgery/Excision Surgery, what to expect for side effects and monitoring, and how choices shift when planning pregnancy or navigating Menopause & Hormonal Transitions.

What is usually tried first for endometriosis pain, and how is it chosen?

Many start with continuous combined hormonal contraceptives or a progestin (such as norethindrone acetate or dienogest where available) or natural compounded progesterone; the levonorgestrel IUD is another effective option for pain and heavy bleeding. Selection depends on symptoms, bleeding goals, migraine or clot risk, tolerance of hormones, and whether future fertility is being timed. It is prudent to obtain a correct diagnosis, which can only be obtained via minimally invasive surgery at this time.

Do medications shrink or cure endometriosis?

Medicines suppress hormonal stimulation of lesions and reduce inflammation, easing pain and sometimes reducing cyst or lesion activity, but they do not remove disease. Symptoms often return when treatment stops; after excision, ongoing suppression can lower the risk of recurrent pain and endometriosis itself.

How do GnRH agonists and antagonists compare, and why use add-back therapy?

Both agonists and antagonists lower estrogen to quiet disease; antagonists work rapidly and are oral, while agonists are typically injections with a brief flare before suppression. Add‑back therapy (low‑dose estrogen/progestin or progestin alone) protects bones and reduces hot flashes without meaningfully reducing pain control. Long term therapy is generally not possible due to toxicities and side effects. Even short term treatment with these agents requires extensive risk vs benefit discussion.

Can I use medical therapy if I’m trying to get pregnant?

Most hormonal therapies prevent ovulation and are paused when actively trying to conceive; they do not improve natural fertility. For symptom control while attempting pregnancy, consider non‑hormonal strategies and coordinate timing with fertility plans through Fertility & Reproductive Health or IVF & ART.

What side effects and monitoring should I expect, and how long can I stay on treatment?

Progestogens may cause spotting, mood or acne changes; combination pills carry rare clot risk in susceptible patients. GnRH options can affect bone density, liver, the cardiovascular system and subjective factors such as mood. So add‑back and periodic monitoring are important; many can stay on progestogens or IUDs long term if well‑tolerated, while GnRH regimens are generally time‑limited with follow‑up to protect bone health.