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 the chronic pain associated with endometriosis, improve patients' quality of life, 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. An advantage of some medications is also a reduced risk of new endometrial cysts or adhesions developing. Unfortunately, a drawback of available medications is that they only work while they are being used. After discontinuation, symptoms usually recur within a few weeks or months. Therefore, the effect is not permanent, and pharmacotherapy does not permanently eliminate endometriosis . 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. Another 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 into anything. Decisions regarding your health are yours alone. The role of specialists is to present all available options, considering their advantages and benefits, as well as potential risks. Don't be afraid to ask questions, and if you feel you haven't been heard, understood, or received comprehensive answers, seek another specialist. Pharmacological treatment can be very helpful, but it's not indifferent to the body. Before starting treatment, you should feel 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's also worth remembering that as awareness of endometriosis grows, approaches to its treatment are changing. Numerous studies are being conducted to assess the impact of new substances on the course of the disease and alleviate symptoms . The scope of medical services in public healthcare facilities, as well as drug reimbursement policies, are also changing. The coming months and years may bring many changes in this area, so seek out specialists who are up-to-date and can offer 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 suppress 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), initiating endometriosis treatment with hormone therapy is appropriate provided the patient has been thoroughly informed about all treatment options, their effectiveness, and possible side effects.

Combined hormonal contraception and endometriosis

Combined contraceptives (COCs) are medications containing estrogen and progestin. Their use inhibits ovarian hormonal activity (including estrogen production), ceasing the menstrual cycle and menstruation. They can also inhibit the growth of endometrial tissue and reduce inflammation. This positive therapeutic effect appears 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 ), painful defecation, and chronic pelvic pain.

Combined contraceptives contain varying doses of hormones and can be used in different regimens: continuous and intermittent. When choosing this form of treatment, the criterion should be the lowest possible dose of ethinylestradiol (EE). In practice, this means taking the lowest effective dose to minimize the risk of side effects. The choice of regimen is also important. In the case of 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 if the patient is not planning to become pregnant in the near future. Unfortunately, oral hormonal contraception is not neutral to the body and can cause side effects such as unintended weight gain, acne, memory and concentration problems, mood disorders, and an increased risk of thromboembolism . If you decide to use estrogen-progestogen medications, it's worth considering routes of administration other than oral. Vaginal rings are an alternative. They release hormones locally, helping to alleviate the symptoms of endometriosis, while the risk of systemic side effects and adverse reactions is much lower than with oral pills. If you are considering this treatment method, discuss all possible options with your doctor to obtain detailed information about the possible benefits and risks in your specific case.

Progestogens and endometriosis

Progestogens are a group of medications effective in treating pain associated with endometriosis, such as chronic pelvic pain, dyspareunia, and painful periods. Active substances 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 of the endometrium ) and inhibit 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 the use of progestogens is free from any side effects. During therapy, 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 endometriosis therapy in the form of an intrauterine contraceptive containing levonorgestrel. The use of a progestogen-containing 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 a subdermal 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 efficacy of GnRH agonists in treating endometriosis-related pain is estimated at 85-100%, with symptom-free survival ranging from 9 to 12 months after discontinuation. 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. For this reason, they are rarely used as first-line treatments for endometriosis.

GnRH antagonists

GnRH antagonists are the newest class of medications increasingly 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 medication in this group approved for endometriosis is elagolix. It is currently registered in the United States and is part of the FDA-approved drug Orillisa. However, it is not available in Poland . Ryeqo, a drug containing another active ingredient from the GnRH antagonist group, relugolix, in combination with estradiol and norethisterone acetate , is available in Poland. Since October 1, 2025, Ryeqo has been reimbursed in Poland for adult women of reproductive age diagnosed with endometriosis.

If you're struggling with the symptoms of artificial menopause, check out our herbal blend, " Symptoms of Artificial Menopause ." It contains carefully selected ingredients that improve well-being, sleep, and hormonal balance.

Aromatase inhibitors

Aromatase inhibitors are another group of medications used to alleviate the symptoms of endometriosis. They are most often used as part of combination therapy and combined with other medications such as progestogens, combined estrogen-progestogen preparations, or GnRH analogues . They work by inhibiting the peripheral conversion of androgens to estrogens. When combined with other medications, aromatase inhibitors reduce pain and improve the quality of life of 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 primarily used 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 . While they may reduce menstrual pain, they do not affect hormonal balance, do not eliminate the underlying cause of the condition, and their effects are 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 valuable support for endometriosis treatment. I described their effects in detail in the article " Herbs for Endometriosis ." However, 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 are taking medications and would like to support your body with herbs, remember the following:

• 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. 

Źródła:

1. Wilk K. The use of nonsteroidal anti-inflammatory drugs in gynecology, https://www.forumginekologii.pl/artykul/zastosowanie-niesteroidowych-lekow-przeciwpaleniech-w-ginekologii [accessed: 04/11/2025]
2. Marjoribanks J. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea, https://pubmed.ncbi.nlm.nih.gov/26224322/ [accessed: 04/11/2025]
3. Brown J. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis, https://pubmed.ncbi.nlm.nih.gov/28114727/ [accessed: 04/11/2025]
4. Kamiński P. The use of ultra-low-dose two-component contraceptive pill in patients with endometriosis, https://www.forumginekologii.pl/artykul/zastosowanie-ultraniskodawkowej-dwuskladnikowej-tabletki-antycepcej-u-pacjentek-z-endometrioza [access: 04/11/2025]
5. Recommendations of the Polish Society of Gynecologists and Obstetricians regarding the management of women with endometriosis, Practical Gynecology and Perinatology 2024, https://pokonacendometrioze.pl/wp-content/uploads/2024/08/101846-439375-1-SM.pdf [accessed: 04/11/2025]
6. Wójtowicz M. Modern contraceptive methods in the treatment of endometriosis, https://www.forumginekologii.pl/artykul/nowoczesne-metody-antycepłe-w-leczeniu-endometriozy [accessed: 04/11/2025]
7. Samulak D. Pain treatment in women with endometriosis – current recommendations, https://podyplomie.pl/monografie-po-dyplomie/34794,leczenie-bolu-u-kobiet-z-endometrioza-aktualne-rekomendacje [access: 04/11/2025]
8. Bielecka W. Dienogest in the treatment of endometriosis, https://www.forumginekologii.pl/artykul/dienogest-w-leczeniu-endometriozy [access: 04/11/2025]