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Managing endometriosis: treatment, symptoms, and support
Top things to know:
Endometriosis treatment is now based on symptoms, exams, and imaging results without the need to wait for surgery
Treatment is individual and may include non-hormonal pain management, hormonal therapy, surgery, or a combination of approaches
Newer medications, such as oral gonadotropin-releasing hormone (GnRH) antagonists, offer more choices when first‑line treatments don’t help enough
You can track your symptoms in the Clue app to better understand your patterns and prepare to discuss with your healthcare provider
What is endometriosis?
Endometriosis is a long-term, inflammatory condition (1). It occurs when tissue similar to the lining of the uterus, called endometrium, grows in other parts of the body (2).
These growths can develop on the ovaries, fallopian tubes, and other areas inside the pelvis (2). They can also grow on the bladder, bowel, and rarely, around the lung (2,3). Endometriosis is driven by the hormone estrogen, meaning this hormone helps the tissue grow (1).
During your menstrual cycle, this tissue responds to hormonal changes just like the uterine lining. This can trigger inflammation, tissue scarring, and pain (2).
Experts now recognize that endometriosis can affect more than the reproductive organs. It may contribute to fatigue, bowel and bladder symptoms, mood changes, and pain in other parts of the body (1,4).
Endometriosis is common, affecting around 1 in 10 people of reproductive age worldwide (5). Yet getting an endometriosis diagnosis is often delayed. Symptoms can be mistaken for other conditions or dismissed as “normal” period pain. It can take anywhere from 4 to 11 years after symptoms begin to receive a diagnosis (1).
Treatment is individual and depends on your symptoms, overall health, and personal goals. People often use a combination of treatments to help manage symptoms and improve their quality of life (1,6,7).
When to talk to a healthcare provider
If any of the following symptoms sound familiar, it’s a good idea to schedule an appointment with your healthcare provider (1,8):
Chronic pelvic pain
Pain during or after sex
Pain with bowel movements or urination, especially during your period
Gastrointestinal symptoms
Fatigue
Difficulty becoming pregnant
Having more than one of these symptoms makes it even more important to speak with a healthcare provider (1). But you don’t need to have every symptom on this list. Your symptoms don’t need to be severe to seek help, either.
As it can take years from symptom onset to receive a diagnosis, many people see multiple healthcare providers during this delay and often receive incorrect diagnoses before endometriosis is identified (8).
How to track endometriosis symptoms
You can track your symptoms in the Clue app, including bleeding, spotting, pain (including pain levels: mild, moderate, severe, and excruciating), energy, feelings, and more.
This can help you notice patterns and give you information to take to your healthcare provider, which can help them make a more informed assessment (9).
If you don’t feel heard, it’s okay to seek out a healthcare provider who listens. Advocating for yourself can feel uncomfortable. Consider bringing a trusted friend or family member to your appointment. Above all, find a provider who takes your concerns seriously and works with you to find answers.
Getting a diagnosis in 2026
Getting diagnosed with endometriosis looks very different today than it did even a few years ago (1). Here’s what you can expect when you seek care:
Clinical diagnosis vs. surgery
For many years, healthcare providers relied on a laparoscopy to confirm endometriosis before starting treatment (1). During a laparoscopy, a surgeon makes tiny cuts in the abdomen and uses a small camera to look inside the pelvis (10).
Healthcare providers still use a laparoscopy to definitively confirm endometriosis (11). But experts recognize that waiting for this procedure can delay care, and it can leave people struggling with pain and other symptoms in the meantime (1).
The American College of Obstetricians and Gynecologists (ACOG) now recommends that a clinical diagnosis is enough to begin endometriosis treatment (1).
To make a clinical diagnosis, healthcare providers consider your symptoms, physical exam, and imaging results (1). They can then begin treatment if they strongly suspect endometriosis is the cause, even without confirmation from surgery (1).
The National Institute for Health and Care Excellence (NICE) and the European Society of Human Reproduction and Embryology (ESHRE) also support starting endometriosis treatment before confirming the diagnosis with surgery in many cases (6,7).
The role of imaging (ultrasound and MRI)
Your healthcare provider may also recommend imaging tests (1,7).
A commonly used imaging test for endometriosis is a transvaginal ultrasound (TVUS) (6). This test helps give a closer look at the pelvic organs. It can help detect ovarian cysts caused by endometriosis (endometriomas) and some deeper forms of the disease (1,6,7).
Your healthcare provider may also recommend a magnetic resonance imaging (MRI) for a more detailed look (1,6,7).
A normal imaging does not rule out endometriosis (6). Some lesions are too small to appear on imaging tests (6). Because of this, your symptoms and medical history are still very important (1).
Non-hormonal pain management
Hormonal treatments can be used to manage endometriosis symptoms, but there are also ways to manage pain with non-hormonal treatment (12,13).
NSAIDs and Inflammation
Nonsteroidal anti-inflammatory drugs (NSAIDs) help provide pain relief (13). They work best when taken before the period starts, or at the first sign of pain. They help reduce prostaglandin levels, which are inflammatory substances that can activate pain signals (14). An NSAID may be used alone or with acetaminophen (Tylenol) (7).
Common NSAIDs available without a prescription include:
Ibuprofen
Naproxen
It’s recommended to take NSAIDs with food to reduce the chance of stomach upset, and avoid using them long-term without guidance from your healthcare provider (15).
Talk with your healthcare provider about other options if your pain continues despite taking NSAIDs.
If you’re trying to conceive, check with your healthcare provider before using NSAIDs regularly, as some NSAIDs may interfere with ovulation in some people (16).
Neuromodulators for chronic pain
Endometriosis pain can become chronic. This can make the nervous system more sensitive to pain signals. In these cases, healthcare providers may recommend neuropathic pain medications, sometimes called neuromodulators (7,17).
These medications can help decrease overactive pain signals (17). Examples include:
Gabapentin
Pregabalin
Some antidepressants may also help with chronic pain, such as (17):
Amitriptyline
Duloxetine
These medications are not usually used as a first treatment. Research on these medications mostly comes from studies on chronic pain in general, not endometriosis specifically (12). Your healthcare provider can help you decide if they’re appropriate for you.
Hormonal treatments
Hormonal treatments help keep hormone levels more stable, which can reduce the activity of endometriosis tissue (12). This can help reduce pain, bleeding, and inflammation (12). The appropriate choice depends on your symptoms, your health history, and fertility goals.
Combined and progestin-only contraceptives
Hormonal birth control is commonly used to manage endometriosis pain (6,7). Combined options contain both estrogen and progestin (6,7,12). They include the birth control pill and the vaginal ring (7).
Many healthcare providers recommend using these treatments continuously without the monthly break (6). This can reduce or stop periods altogether, and it may also reduce pain flares over time (6,18).
Combined hormonal contraceptives may help improve (6):
Painful periods
Pain during sex
Non-menstrual pain
Progestin-only treatments are another option. They contain no estrogen. They work by reducing the activity of endometrial tissue (18).
Dienogest is the most studied progestin-only option (12). It can help reduce pelvic pain and painful periods. It’s also considered safe for long-term use (18).
Other progestin-only options include (6):
Fertility usually returns after stopping hormonal treatment, and there’s no evidence that these treatments have a permanent negative effect on future fertility (7).
GnRH antagonists and agonists
Gonadotropin-releasing hormone (GnRH) agonists and antagonists lower estrogen levels in the body. Since endometriosis tissue responds to estrogen, these treatments can make this tissue less active and may help reduce symptoms (6,18).
These medications tend to cause more side effects than combined and progestin-only contraceptives. Healthcare providers use them if other hormonal treatments have not provided enough relief (12).
GnRH agonists, such as leuprolide, are given as an injection or implant (13). They can briefly raise hormone levels before estrogen drops, called a hormone flare (13). Side effects may include hot flashes, mood changes, and bone density loss (18).
They’re usually only used for a limited time. Healthcare providers sometimes prescribe low-dose hormone therapy alongside these medications to help reduce their side effects and protect bone health (6,12,18).
GnRH antagonists are pills taken daily. They also lower estrogen levels. They don’t cause the temporary hormone flare seen with GnRH agonists and tend to work faster (18).
Options include (12):
Elagolix
Relugolix combination therapy
Every person responds differently to hormonal treatment. Ask your healthcare provider about the benefits, side effects, and how each option may affect your fertility goals. It’s okay to revisit the conversation if something isn’t working.
Surgical options
Surgery is not the first step for most people with endometriosis (1,6). In some cases, it can help relieve pain and improve fertility (7). Your symptoms, treatment goals, and the location of the endometriosis help determine which surgical option is appropriate (7).
Laparoscopic excision vs. ablation
There are two main types of laparoscopic procedures used to treat endometriosis (19,20):
Excision, which cuts out and removes endometriosis tissue
Ablation, which burns or destroys the tissue using heat
Both can help reduce pain (19). Excision may provide better long-term relief for painful periods, chronic pelvic pain, and quality of life (20,21). For superficial or mild endometriosis, both laparoscopic approaches have similar outcomes (19).
Excision is often preferred when treating endometriomas. This is especially true for people who want to preserve fertility (7).
Endometriosis symptoms can return after either procedure. Some people continue hormonal treatment after surgery to help manage symptoms and minimize the chance of recurrence (7).
When is a hysterectomy recommended?
A hysterectomy is a surgical procedure to remove the uterus (22). In some cases, the surgeon may also remove the ovaries and fallopian tubes (22). After a hysterectomy, you can no longer become pregnant (7).
Healthcare providers usually only consider this surgery after other treatments have been tried without success (23).
About 1 in 4 people still experience pelvic pain after this procedure (23). And about 1 in 10 may need additional surgery or treatment (23).
If the ovaries are removed, menopause starts immediately, and this can cause hot flashes, mood changes, and bone density loss. Hormone replacement therapy (HRT/MHT) may help manage these symptoms (6,7). This may occur if some endometriosis tissue was missed during surgery.
A hysterectomy for endometriosis is a major decision. Talk with your healthcare provider about the risks, benefits, and alternatives before moving forward (7).
Endometriosis and fertility treatment
People with endometriosis are 2 to 4 times more likely to experience infertility compared to those without the condition (24). Still, many people with endometriosis do conceive naturally (25).
Endometriosis can affect fertility in several ways (26):
Scar tissue can block or change the shape of the fallopian tubes or ovaries
Inflammation may affect egg quality and make fertilization more difficult
Endometriomas may affect egg supply (ovarian reserve)
Changes in the uterine lining may make it harder for a fertilized egg (embryo) to attach (implant) and grow
Fertility treatment options
Many factors can determine which fertility treatment may be appropriate for you. These include your age, ovarian reserve, and the severity of your endometriosis (6).
But many treatment options are available, including (6):
Surgery to remove endometriosis tissue or endometriomas, which may improve the chance of a natural pregnancy
Intrauterine insemination (IUI) with ovarian stimulation for mild endometriosis
In vitro fertilization (IVF), especially if the fallopian tubes are damaged, or fertility is significantly affected
Hormonal treatments can help manage endometriosis pain, but they’re not fertility treatments. Because they prevent pregnancy, you cannot use them while trying to conceive (6).
Managing infertility on top of endometriosis can feel overwhelming. A fertility specialist familiar with endometriosis can help you understand your options and create a treatment plan that fits your goals.
Complementary and lifestyle support
Many people find that adding complementary approaches and lifestyle adjustments to medical treatment helps them manage the symptoms of endometriosis more effectively. But these approaches don’t cure endometriosis. Here are a few that may be helpful:
Pelvic floor physical therapy (PFPT)
Endometriosis can cause the pelvic floor muscles to become tight and painful. Pelvic floor physical therapy (PFPT) can help relax and retrain these muscles (27).
It uses stretching, relaxation techniques, and manual therapy. PFPT may help reduce pelvic pain and pain during sex (17,27).
Talk to your healthcare provider about PFPT and ask for a referral to a pelvic floor specialist.
Diet and nutrition
The Mediterranean diet has the strongest evidence for endometriosis symptom management (28). It focuses on vegetables, fruits, whole grains, legumes, olive oil, and fish. It also limits highly processed foods and red meat. It can help reduce pelvic pain and painful bowel movements in people with endometriosis (28,29).
A low FODMAP diet may help if bloating and digestive symptoms are a problem (28). This diet limits certain carbohydrates that can trigger gas and bloating. About 2 out of 3 people with endometriosis-related bowel symptoms noticed improvement with this diet (28).
A registered dietitian can help you find an appropriate nutrition plan.
Other pain relief options
Some people find pain relief from other non-medication tools alongside medical treatment. These include:
Transcutaneous electrical nerve stimulation (TENS), which uses mild electrical pulses to interrupt pain signals. It can help reduce chronic pelvic pain and pain during sex (27)
Heat therapy, such as a heating pad or warm bath, to help relax pelvic muscles (29)
Yoga to help reduce stress and support overall well-being (28,29)
Regular physical activity helps lower inflammation (27)
Next steps
Endometriosis is a complex condition, but treatment options have come a long way. Healthcare providers can now start treatment based on symptoms, exams, and imaging without waiting for surgery (1).
Don’t wait to schedule an appointment with your primary care provider or gynecologist if you have symptoms. In the meantime, here are some steps you can take right now:
Track your symptoms using the Clue app
Write down questions about treatment and imaging options
Bring a trusted friend or family member for support if needed
If you don’t feel heard, keep seeking answers and support.
FAQs
Can endometriosis be cured, or will I always have it?
Endometriosis is a chronic condition that requires ongoing management (1). But many people can manage their symptoms with treatment, lifestyle changes, surgery, or a combination of approaches (6).
Will getting pregnant treat or cure my endometriosis?
Pregnancy is not a treatment or cure for endometriosis. Symptoms may improve temporarily during pregnancy due to hormonal changes (6). But they may return after delivery (30).
Is it safe to use hormonal birth control long-term for endometriosis?
Hormonal birth control is considered safe for long-term use for endometriosis for most people under a healthcare provider’s guidance (7). It doesn’t cause permanent fertility problems after stopping (7). Your healthcare provider can help you weigh the benefits and possible risks based on your health history and treatment goals.
