Treating the Severe Pelvic Pain of Endometriosis

January 24, 2024

Endometriosis is a condition that affects many women and is one of the most common sources of pelvic pain.

While we don’t know exactly what causes endometriosis or how to prevent it, there are ways to manage the symptoms. The pain from endometriosis can be debilitating, and women no longer need to suffer needlessly with the variety of treatment options available, says University Hospitals OB/GYN Lauren Griebel, MD.

Pain That Interferes With Daily Life

Endometriosis occurs when cells similar to the cells that line the inside of the uterus are found in the pelvis, outside the uterus. Just like the lining of the uterus, this tissue thickens and breaks down with each menstrual cycle. But the tissue has no way to leave the body, so it become trapped. The buildup of endometrial tissue can lead to inflammation, scarring and other issues in and around the reproductive organs.

This can cause a variety of symptoms, including very painful periods, pain with sex, and pain with urination and bowel movements. Repeatedly tensing up the pelvic muscles in response to this pain can lead to even more painful muscle spasms that won’t relax on their own. Scar tissue from endometriosis can also make it difficult for some women to get pregnant.

Endometriosis affects up to 10 percent of women of childbearing age, and there are likely many more women affected but undiagnosed. For many, endometriosis is a huge source of chronic pain, which can interfere with everyday life. Dr. Griebel says this type of debilitating pain is not normal, and anyone experiencing it should talk to their doctor.

“If you are experiencing extreme pelvic and period pain that makes you miss days of school or work, something else is probably going on," she says.

Treating Endometriosis

Surgery is the only way to definitively diagnose endometriosis, though symptoms can be managed without an actual diagnosis. During a diagnostic laparoscopic surgery, the surgeon uses a thin tube and camera inserted through the abdomen to look at the tissue around the uterus. They can then take a sample of any suspicious tissue and perform a biopsy. The biopsy can confirm if the patient has endometriosis.

Endometriosis can be managed with medication, surgery or both:

Medication. Medical management focuses on suppressing endometriosis and its symptoms. This is the preferred initial treatment, especially for younger patients. It can slow the growth of endometrial tissue, help prevent the disease from advancing, and make patients feel a lot better, says Dr. Griebel.

Medications can include birth control pills and other hormonal contraceptives such as Nuvaring and intrauterine devices (IUDs). Another medication that can be prescribed for endometriosis is Orilissa (elagolix). This medication can decrease the body’s estrogen levels, which can be helpful for relieving endometriosis pain.

Surgery. There are an array of surgeries used to treat endometriosis, depending on the severity and other individual factors. Laser ablation uses heat to destroy the endometrial tissue and may be helpful for patients with milder endometriosis. Surgically removing the endometrial tissue, or excision, is the preferred surgical treatment for most patients and is thought to improve long-term pain control and slow the recurrence of endometriosis. Both surgeries are done laparoscopically, through small incisions in the abdomen.

Research indicates that a hysterectomy, or surgery to remove the uterus, is not an effective treatment for endometriosis. Dr. Griebel says it doesn’t prevent reoccurrence, and is not a cure. Hysterectomy also makes pregnancy impossible, so it should not be considered unless the patient is no longer interested in preserving their fertility.

Pain management. In addition to medication and surgery, endometriosis pain can be controlled with pelvic floor therapy and intermittent muscle relaxers.

Infertility and Pregnancy

While some women with endometriosis experience infertility, others do not have a problem getting pregnant. Scar tissue from endometriosis can block the fallopian tubes and cause inflammation that may make pregnancy more difficult to achieve. Surgery to remove endometrial and scar tissue can help these women increase their chances of getting pregnant.

Women with endometriosis can safely carry a pregnancy to term, and endometriosis alone doesn’t put a woman at higher risk for pregnancy complications, though it may make it harder to perform a C-section if needed. Once pregnant, many women find they feel better and have less pain since they’re no longer experiencing menstrual periods.