What medications should I take for endometriosis?

Drug therapy is one of the available treatments for endometriosis. Unfortunately, many myths surround endometriosis medications. On the one hand, you might hear that they don't cure the condition at all, but merely mask symptoms and increase the risk of other problems. On the other hand, many endometriosis patients experience significant relief after using them and are finally able to function normally. In this article, I've gathered the most important information about the main medications used to treat endometriosis to provide you with an understanding of the topic, presenting both the benefits and potential risks. You can use this information as a starting point for a conversation with your doctor.

Pharmacological treatment of endometriosis – effectiveness and safety 

The main goal of pharmacotherapy is to reduce or completely eliminate chronic pain associated with endometriosis, improve the quality of life of patients and reduce the need for surgical interventions. In this context, medications can be truly effective. Many women experience significant improvement after starting medications and feel they can finally function normally. Some medications also have the advantage of reducing the risk of new cysts or endometrial adhesions. Unfortunately, a drawback of available medications is that they only work when they are used. After discontinuation symptoms usually recur within a few weeks or months. The effect is not permanent, and drug therapy does not make endometriosis disappears once and for all. Endometriosis medications, like any other, can cause side effects and adverse reactions that you should be aware of before making a decision about your health. A potential drawback is that available medications do not directly improve fertility in endometriosis. On the contrary, most medications "shut down" the natural hormonal and menstrual cycles, making it impossible to get pregnant during treatment.

As you can see, this topic is complex and multifactorial. There's no single, right answer to the question of whether medication is necessary for endometriosis, nor which medication is best. The choice of treatment always depends on the context, individual needs, and expectations. Remember, no one can impose anything on you or force you to do anything. Decisions regarding your own health are yours alone to make. The role of specialists is to present you with all available options, taking into account both their advantages and benefits, as well as potential risks. Don't be afraid to ask questions, and if you feel like you haven't been heard, understood, or received comprehensive answers, look for another specialist. Treatment Pharmacological treatment can be very helpful, but it is not neutral to the body. Before you begin, you should feel confident you're in good hands. If you haven't found a doctor you can trust yet, check out our list of recommended specialists. 

Endometriosis medications

Available medications for endometriosis include:

• Nonsteroidal anti-inflammatory drugs,
• Combined contraceptive pills,
• Progestogens,
• GnRH agonists and antagonists,
• Aromatase inhibitors. 

The choice of pharmacological treatment should be based on the patient's individual tolerance, side effect profile, cost, and other preferences. The decision is yours. Remember, you can always change it. If you don't notice any improvement while taking the medication, or if any new, disturbing symptoms appear, report it to your doctor. The specialist's role is to plan a new course of action. Medications are for you, to help you feel well despite your illness. They are not a punishment for getting sick, and if they make you feel worse than before, you are not condemned to them. 

It is also worth remembering that as awareness of endometriosis increases, the approach to its treatment is changing. Numerous studies are being conducted survey assessing the impact of new substances on the course of the disease and alleviating symptomsThe scope of medical services in state-funded medical facilities is also changing, as are the rules for reimbursement of medications. The coming months and years may bring many changes in this regard, so seek out specialists who are up-to-date and can offer you treatment consistent with the current state of knowledge and medical possibilities. 

Hormonal drugs in the treatment of endometriosis

Endometriosis is a hormone-dependent disease associated with cyclical ovarian activity. Therefore, its treatment involves medications that reduce the production of certain hormones and disrupt the menstrual cycle. These include oral contraceptives, progestogens, GnRH agonists and antagonists, and aromatase inhibitors. According to the recommendations of the European Society of Human Reproduction and Embryology (ESHRE) and the Polish Society of Gynecologists and Obstetricians (PTGiP), starting endometriosis treatment with hormone therapy is the right course of action, provided that the patient has been thoroughly informed about all treatment options, their effectiveness and possible side effects.. 

Combined hormonal contraception and endometriosis

Combined (combined) contraceptives are medications that contain estrogen and progestogen. Their use inhibits ovarian hormonal activity (including estrogen production), halting the menstrual cycle and menstruation. They can also stop the growth of endometrial tissue and reduce inflammation. The positive therapeutic effect seems particularly beneficial in patients for whom painful periods are the primary symptom of endometriosis. However, many women also report improvement in other symptoms, such as painful intercourse (dyspareunia), pain during defecation and chronic pelvic pain. 

Combined contraceptives contain different doses of hormones and can be used in different schedules: continuous and intermittent. When choosing this form of treatment, the criterion should be the lowest possible dose of ethinylestradiol (EE) in the preparation. In practice, this means taking the lowest effective dose to minimize the risk of side effects. The choice of regimen is also important. For endometriosis, continuous medication (every day, without a break) is often more effective than a cyclical regimen, which involves taking the medication for 21 days followed by a 7-day break. 

Combined hormonal contraception is highly effective in relieving endometriosis and is often recommended as first-line treatment, provided the patient does not plan to become pregnant in the near future. Unfortunately, oral hormonal contraception is not neutral to the body and may cause side effects such as unintentional weight gain, acne, problems with memory and concentration, mood disorders, as well as an increased risk of thromboembolic complications.If you decide to administer estrogen-progestogen medications, it is worth considering routes of administration other than oral. An alternative are vaginal rings. They release hormones locally, helping to alleviate the symptoms of endometriosis. The risk of systemic side effects and side effects is much lower than with oral pills. If you're considering this treatment method, talk to your doctor about all possible options for detailed information on the potential benefits and risks in your specific case.

Progestogens and endometriosis

Progestogens are a group of drugs effective in treating pain associated with endometriosis, such as chronic pelvic pain, dyspareunia, and painful periods. Active substances included in this group include:

• Norethisterone acetate,
• Medroxyprogesterone acetate,
• Dienogest,
• Desogestreol. 

The mechanism of action of progestogens in the treatment of endometriosis is to inhibit the development of its foci, reduce the activity of tissue metalloproteinases (enzymes involved in the growth endometrium) and inhibiting angiogenesis, i.e. vascularization of endometrial foci. 

The advantage is that the therapy is based solely on progestogen. Unlike combined hormonal contraceptives, the risk of side effects related to the estrogen component is lower. However, this does not mean that progestogens are free from any side effects. During treatment, spotting, weight gain, mood swings, headaches, and constipation are possible. Long-term treatment also increases the risk of lipid disorders, so regular blood tests and cardiovascular risk assessment are recommended.

The most commonly used oral medication is dienogest. It is the active ingredient in medications such as Visanne, Probella, Aridya, Endofemine, Diemono, and Endovelle, which are partially reimbursed. 

To reduce the risk of systemic side effects, progestogens can be introduced into the treatment of endometriosis in the form of intrauterine contraception containing levonorgestrel. The use of a progestogen-based IUD significantly improves the clinical condition of patients with superficial or deeply infiltrating endometriosis, particularly those with endometrial lesions in the rectovaginal septum. The most common side effects include increased spotting and breakthrough bleeding, headaches, and breast tenderness. 

Another alternative is subcutaneous implant. It contains etonogestrel, which is continuously released for three years. Its advantages include high efficacy and a rapid return of fertility after discontinuation, allowing for pregnancy planning. Furthermore, the implant can be removed at any time. The most common side effects include irregular bleeding at the beginning of therapy, excessive skin pigmentation around the implant, breast tenderness, and acne-like skin lesions. 

GnRH agonists

An important group of medications that may be considered in the treatment of patients with endometriosis-related pain are GnRH agonists, or gonadoliberins. GnRH is a hormone produced by the hypothalamus that stimulates the pituitary gland to produce gonadotropins: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). GnRH agonists inhibit the production of these hormones. This results in the cessation of ovulation and menstrual bleeding, inducing a state similar to menopause. 

The most commonly used compounds from this group are: 

• Leuprorelin (parenterally administered), 
• Triptorelin (administered by intramuscular injection), 
• Nafarelin (available as a nasal spray),
• Goserelin (subcutaneous implant). 

The effectiveness of GnRH agonists in the treatment of pain associated with endometriosis is estimated at 85-100%, and the period without recurrence of symptoms is 9 to 12 months after discontinuation of therapy. Unfortunately, their use is associated with numerous side effects, including vaginal dryness, hot flashes, acne, headaches, and weight gain. The risk of bone loss also increases significantly, especially with long-term therapy and when taken in high doses. Importantly, the risk of side effects is independent of the route of administration. Therefore, they are rarely used as first-line treatments for endometriosis. 

GnRH antagonists

GnRH antagonists are the newest group of drugs that are increasingly being used to treat pain associated with endometriosis. They immediately inhibit the production of sex hormones produced by the pituitary gland and suppress the menstrual cycle. This induces a state of artificial menopause. This method is used not only for endometriosis but also for adenomyosis and uterine fibroids. The body then functions as it would during a natural menopause, which is why characteristic menopausal symptoms may occur, such as hot flashes, vaginal dryness, night sweats, decreased libido, mood swings, fatigue, and headaches. Long-term use of these medications also increases the risk of bone mineral density loss. Although GnRH therapy provides symptomatic relief by reducing pain, its effects are short-lived, and symptoms return after treatment is discontinued. 

The first oral drug from this group approved for use in endometriosis is elagolix. It is currently registered in the United States and is part of the drug Orillisa, which has been approved by the U.S. Food and Drug Administration (FDA). However, it is not available in Poland.In our country, the drug Ryego is available, which contains another active substance from the group of GnRH antagonists – relugolix in combination with estradiol and norethisterone acetate.. From October 1, 2025, the drug Ryeqo is reimbursed in Poland for adult women of reproductive age diagnosed with endometriosis. 

If you are struggling with the symptoms of artificial menopause, check out our herbal blend "Symptoms of artificial menopause” Contains carefully selected ingredients that improve well-being, sleep, and hormonal balance. 

Aromatase inhibitors

Aromatase inhibitors are another group of drugs used to relieve the symptoms of endometriosis. Most often, they are part of combination therapy and are combined with other drugs such as progestogens, combined estrogen-progestogen preparations or GnRH analogues.They act by inhibiting the peripheral conversion of androgens to estrogens. When combined with other medications, aromatase inhibitors reduce pain and improve quality of life in patients with endometriosis. Unfortunately, their use is associated with side effects such as decreased bone mineral density, which increases the risk of fractures, vaginal dryness, nausea, headaches, and hot flashes. Currently, aromatase inhibitor therapy is mainly performed in women who have already tried other treatment options without the desired effect.  

Nonsteroidal anti-inflammatory drugs in the treatment of endometriosis

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a broad group of medications used to support the treatment of many conditions characterized by pain and inflammation. Their mechanism of action involves inhibiting cyclooxygenase (COX), an enzyme involved in the synthesis of pro-inflammatory prostaglandins. As a result, their use reduces the levels of prostaglandins responsible for inflammation and pain.

NSAIDs are effective in reducing primary dysmenorrhea, but their effect on secondary dysmenorrhea associated with endometriosis is unclear.On the one hand, they can reduce menstrual pain, but on the other hand, they don't affect hormonal balance, don't eliminate the cause of the condition, and their effect is only temporary. Despite this, they have relatively few side effects (when dosed appropriately!) compared to hormonal medications, and their great advantage is their excellent availability. 

When using NSAIDs, remember to use them according to your doctor's instructions and not exceed the recommended doses. Excessive or incorrect dosages can cause gastrointestinal symptoms and even contribute to gastritis and peptic ulcers, and can affect blood clotting and liver function. It's understandable that when you experience pain, you want relief as quickly as possible, but uncontrolled medication use can lead to further health problems. 

Endometriosis medications and herbs – what to watch out for?

Herbs are a very valuable element in supporting the treatment of endometriosis. I described their effects in detail in the article "Herbs for endometriosisHowever, great caution should be exercised when using concurrent pharmacological treatments. Unfortunately, medications and herbs can interact, weakening each other's effectiveness, or exacerbating side effects and adverse reactions. If you take medications and also want to support your body with herbs, remember the following rules:

• Read the leaflet that comes with the medication carefully and check the section on interactions. You'll find information there about what the medication should not be combined with. Make sure it doesn't include any herbs you're using.
• Never take herbal infusions with medications. A minimum of two, preferably three, hours should elapse between taking medications and herbs to reduce the risk of adverse interactions. In some situations, this interval may be longer, so it's worth consulting your doctor or dietitian.
• More isn't always better. The more medications, supplements, and herbs you take, the greater the risk of interactions between individual ingredients. Therefore, taking a dozen different herbs at once in combination with medications isn't a good idea. It's worth choosing one herb or herbal blend and using it for a few weeks, then switching to another, rather than combining them simultaneously. 

Summary

Properly selected pharmacotherapy can reduce the symptoms of endometriosis and improve your daily comfort. The choice of medication is highly individual and should take into account your overall health, test results, predominant symptoms, preferences, financial resources, and reproductive plans. Remember, the decision to use or not use medication is yours alone, and you have the right to make it after receiving full information about both the benefits and potential risks. 

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