Pros and cons of endo treatment options

One question I get A LOT in my DMs is what are the different treatment options for endometriosis and the pros and cons of each.

As I've stated before, endometriosis is a full body disease that affects more than just your reproductive organs. It affects the immune system and also has genetic + environmental components. So in order to properly manage and address this disease, we have to look at the full picture, instead of just focusing on hormones alone in order to truly improve our quality of life. 

So let’s dive into the 6 common treatment options that are available to those with endo.

#1 Hormonal Birth Control- the pill, IUD, patch, or depot shot. 

If you have endometriosis, brutal periods or a doctor suspects that you do, you've probably been offered hormonal birth control to help improve symptoms and stop the growth of the disease. 

PROS: can reduce or stop bleeding, reduce period pain and PMS symptoms that commonly present with endo. It can be super convenient and easy to keep up with (especially with the IUD), can be less invasive + more affordable than surgery.

CONS: doesn't actually address the root cause of why your endometriosis symptoms or why your period pain is so bad in the first place. A lot of side effects like nutrient deficiencies (of certain vitamins and minerals to help you improve inflammation and overall improve symptoms., thyroid imbalances, blood sugar issues + even gallbladder disease (all of which can affect endometriosis). When you stop the pill, all your symptoms return, and sometimes come back tenfold.  

And I want to note this because I’ve seen this happen with endo women I personally know, endo can develop to stage 4 on birth control, without you actually FEELING the symptoms (which is NOT ideal, especially if your goal is to conceive one day). AGAIN, FULL BODY DISEASE!!! 

They also don’t talk enough about how hormonal birth controls with estrogen have the potential to further drive this disease. And even if they don’t contain estrogen, progestins/ birth control work to BLOCK ovulation + hormone production (especially progesterone) + this hormone is important for improving endo pain, PMS, period pain + other symptoms like histamine reactions that can arise with this disease..

#2. GNRH agonists/ antagonists:

Medications like Lupron, Orlissa, Zoladex, + Myfembree work by shutting production of hormones down in the body. This can induce a menopausal type state and help to suppress growth of endo tissue temporarily.

PROS: can help reduce pain, especially related to the cycle, PMS symptoms, + inflammation which can improve quality of life. 

CONS: doesn’t address the WHY behind your endo symptoms, can cause menopause-like side effects including hot flashes, and bone density loss (which is why they can’t be used long term) Because of that, symptoms often return and the disease can continue progressing.

#3 Ablation Surgery

This is probably one of the most common surgeries that women have had with endometriosis, because this is what most standard OBGYNs are trained to do to treat endo.

PROS: Less invasive/shorter recovery time, burn off visible endometriosis lesions + can improve symptoms short-term.

CONS: doesn’t address the WHY behind your endo symptoms, the tissue is only being burned off superficially vs fully excising the endo lesions from the root, high recurrence rate (60-80% within 5 years post ablation), + people often need repeat surgeries.

I myself had 2 ablations within a 5 year period- was stage 1 at the time and am likely now at stage 3 or 4 with my endometrioma (these are often a sign of more advanced endometriosis).

#4 Excision Surgery (Golden Standard of treatment for endometriosis)

PROS: this actually removes the disease at the root, meaning they’re removing the endo tissue in its entirety, the same way they would remove cancer versus just burning the surface layer of it off. This yields a much lower recurrence rate and majorly improve quality of life and even fertility outcomes.

CONS: you need a HIGHLY skilled surgeon (will drop more info on this in a second), not always covered by insurance (many women pay completely out of pocket leading up to $60k + many providers request up to 10k+ up front prior to surgery), a longer recovery time, and endo can still grow back (though it has a lower recurrence rate than ablation- stats are ~10-15%). 

Skilled surgeons for endometriosis excision can be hard to find, however, there are a few resources online that can help you find some in your area.

The Nancy’s Nook Facebook group is an Endometriosis Support group and inside, they have a list of “Nancy Nook Certified” Endometriosis specialists. The main con to this group is that many surgeons get left off this list, even if they perform excision surgery a LOT because the owner of the group has very strict requirements. For example, there are a handful of surgeons in SC that provide this surgery, however, she has ZERO listed. Another website/resource to find excision surgeons is www.icarebetter.com . You can search for one based on your location!

#5: Holistic/ Functional Medicine:

This is where people like me come in :) This option made the HUGEST improvements in my overall quality of life + even for my clients who have had a few surgeries for endo, or suspect they have it + have never had surgery or been diagnosed. This involves looking at your nutrition, gut health, habits, lifestyle, nervous system, blood sugar, etc.  

PROS: It actually targets the WHY behind your endo symptoms, helps to reduce systemic inflammation without hormone suppression, helps improve overall health + promotes disease prevention, supports overall surgery outcomes.

CONS: This is not a quick fix, lot of trial and error especially if you're navigating this alone and not working with a practitioner, may not provide as immediate of results as surgery, and medical intervention may still be required.

And as I’ve been talking about on my IG lately, I’ve put in SO much work to manage + improve my endometriosis symptoms through addressing my nutrition, gut health, etc, but I am still in need of endometriosis excision surgery. 

#6 Multi-Disciplinary Approach:

This means we are combining both realms of medicine (traditional with surgery and functional with nutrition/lifestyle + other whole body changes) and leaning into other modalities like pelvic floor PT, acupuncture, chiropractor, etc.

PROS: Having a healthcare team to address endometriosis as the FULL BODY disease that it is. This will yield the greatest improvement in symptoms + quality of life by addressing all the possible root causes of your symptoms / pain/ inflammation. 

CONS: You will need to find a healthcare team of providers/ practitioners you can trust and that can be pricey, especially if you're working with a pelvic floor physical therapist, you're working with an acupuncturist, you're working with a nutritionist, and you're also meeting with an excision surgeon.

But the most important thing about endometriosis treatment options is that your treatment plan should be completely personalized to you, your body, your goals and your values, not just what's most convenient for your doctor. OOOP I said it.

And this is where I see traditional medicine (specifically more traditional OBGYNS vs endo specialists) really drop the ball for women is they're so focused on”we want to keep things conservative and avoid surgery” or getting endo ablation mixed up with a uterine ablation (2 totally different surgeries and YES OBGYNS do this commonly :( ) or they're telling women that they don't need surgery and can just rely on the pill to “stop the growth”, even with visible endometriomas on imaging.

Taking a full body approach, diving deeper into the WHY behind your symptoms + seeking out a qualified surgeon is imperative, especially if your goal is to conceive. Fertility issues with endometriosis stem from more than just structural issues. They can also be as a result of poor gut health, nutrient deficiencies, blood sugar imbalances, low progesterone, etc. So if you want to conceive in the next 3-12 months and you have/suspect you have endo, you could 20/10 benefit from a multi-disciplinary approach. Because more often than not it's "just take the pill until you're ready to have a baby and if when you stop it you can't conceive, then we'll do IVF" and you deserve much more than that.

You definitely deserve a surgeon and team that will hear you out,  because you deserve answers, the best care + a majorly improved quality of life. I am a functional nutritionist (with endo) that doesn't just mask symptoms with her endo clients. I help women dramatically change their lives for the better because we actually dig deep into what's actually behind your symptoms + build a completely personalized health plan for them, their bodies + their overall health goals. You don't have to have painful periods just because you have endo. We have options. And my colleague + I run a root-cause focused fertility prep program together. If you'd be curious to learn more, you can do so here.

Because while endometriosis can suck, it does not have to plague your life every single day. If you're ready to talk about how you can improve your outcome after excision surgery OR you just crave taking a whole body approach to this disease, book a consultation call using the link below, or shoot me a DM on Instagram!