Managing symptoms

In short

Pain medicines, hormones, and surgery can ease symptoms. None of them cures the disease. Heat has no evidence grade for endometriosis.

Written by the OpenEndo team · Last reviewed 28 Oct 2026 · No separate clinical review yet

When pain rises

Write it down. When pain rises, note the date, what you could not do, bleeding, bowel and bladder symptoms, and what you tried. (Established)¹
Ask about a short trial. A short trial of paracetamol or an NSAID, alone or together, can be considered for pain. (Uncertain)¹²
Ask for a referral. If that trial does not help enough, ask about other pain care and a referral. (Established)¹
Heat. Heat has no evidence grade for endometriosis. (Not yet shown)¹²

Bring this to your appointment

Work and school

Pain can stop people going to work or school. Tell them which tasks you cannot do on bad days, and bring the diary.³¹

Treatment options

Established
Likely
Uncertain
Not yet shown

Options the guidelines name. They are not ranked. There is no cure, and no doses are given here.

Pain relief

Hormonal

Surgery

Fertility

Support

Pain reliefUncertainUncertain

HormonalEstablishedEstablishedEstablishedLikelyLikely

SurgeryLikelyLikelyUncertain

FertilityEstablishedLikelyLikely

SupportUncertain

1 NICE NG73, updated 2024 · 2 ESHRE guideline, 2022 · 3 WHO fact sheet, 15 Oct 2025

Last reviewed 28 Oct 2026

Show as text

Paracetamol or NSAID. A short trial can be considered for pain, and these medicines may be offered. The trials behind that are very low quality. (Uncertain [1] [2])
TENS. Small trials found some improvement in pain or quality of life. They are low quality, and ESHRE makes no recommendation. (Uncertain [2])
Combined pill. It reduces pain with periods, pain with sex, and pelvic pain. It does not permanently reduce later fertility. It is not used to help you conceive. (Established [1] [2] [3])
Progestogens. Progestogens reduce endometriosis pain. Side effects differ between products. (Established [1] [2])
Hormonal coil. A levonorgestrel coil reduces endometriosis pain. It is also a contraceptive. (Established [2] [3])
GnRH agonist. Second line, because of side effects from low oestrogen. Add-back treatment (low-dose oestrogen and progestogen) is used to protect bone and limit those effects. (Likely [2] [3])
GnRH antagonist. This can be considered. The recommendation is weak, and it is second line. Add-back treatment (low-dose oestrogen and progestogen) limits low-oestrogen effects. (Likely [2] [1])
Excision or ablation. Surgery is one option to reduce pain. A Cochrane review cited for this is uncertain about the size of the effect on overall pain. Lesions can return. (Likely [1] [2] [3])
Ovarian cyst surgery. Removing the cyst wall (cystectomy) is preferred to reduce pain and recurrence. Draining and ablating it may spare more ovarian reserve when fertility is a priority. (Likely [1] [2])
Hysterectomy. Removal of the womb is not a cure. It is considered when other care has not helped and pregnancy is not planned. Visible lesions should be removed at the same time. (Uncertain [3] [2] [1])
Hormones and conception. Hormonal treatment is not offered to raise the chance of conceiving without assistance. (Established [1])
Surgery and conception. Removing peritoneal disease, or treating an endometrioma, can improve the chance of conceiving without IVF. (Likely [1])
Fertility treatment. Ovulation induction, insemination, or IVF may be offered. Among women with infertility, as many as 25 to 50 percent have endometriosis. (Likely [3])
Physio and psychology. Physiotherapy and cognitive behavioural therapy can reduce pain for some people. No specific non-medical treatment is recommended, because benefits and harms are unclear. (Uncertain [3] [2])

Sources

Find care