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Endometriosis
Endometriosis treatment available online today
Request treatment for endometriosis online from our trusted, board-certified primary care doctors and find relief today. Get a new prescription to treat endometriosis or refill an existing prescription today.*
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Understand the different stages of endometriosis
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Learn more about endometriosis
*Prescriptions are provided at the doctor's discretion. Learn more about our controlled substances policy and how to save up to 80% with our prescription discount card. PlushCare doctors cannot treat all cases or symptoms of Endometriosis. Our primary care physicians can conduct an initial evaluation of your symptoms but may need to refer you to an OB/GYN for in-person evaluation and treatment. If you are experiencing life-threatening symptoms, seek emergency medical attention immediately.
Learn about endometriosis
Endometriosis is a gynecological disorder that can range from no symptoms at all to debilitating pelvic pain. It can cause infertility in some people as well. According to the Office on Women's Health, endometriosis affects more than 11% of women between the age of 15 and 44 in the U.S.A.
The endometrium is the tissue that lines the inside of the uterus/womb, that builds up in preparation for possible pregnancy during each menstrual cycle. When pregnancy does not occur, the endometrial tissue is released from the body as menstrual flow.
With endometriosis, the endometrial tissue grows outside the uterus, typically on the:
Fallopian tubes
Ovaries
Outer surface of the uterus
Ligaments connected to the uterus
Bowel wall
Bladder wall
Even outside of the uterus, these tissues continue to respond to hormones of the menstrual cycle. When it breaks down outside of the uterus, the blood is not properly discharged and becomes trapped within the abdomen and pelvis, causing inflammation and scarring of the surrounding tissues. When the ovaries are involved, ovarian cysts called endometriomas may form. Endometriosis is an often painful gynecological disorder, causing pain with intercourse (dyspareunia) and/or pain with menstrual cycles (dysmenorrhea). According to the Office on Women's Health, endometriosis affects more than 11% of women between age of 15 and 44 in the U.S.A, making it harder for the affected patient to conceive.
Stages of endometriosis
According to the American Society of Reproductive Medicine, there are four stages of endometriosis:
Stage 1: Minimal endometriosis
Stage 2: Mild endometriosis
Stage 3: Moderate endometriosis
Stage 4: Severe endometriosis
These different stages of endometriosis reflect the amount, size, depth and location of the endometriosis tissue, and not necessarily the level of endometriosis pain experienced by the patient.
Endometriosis causes
According to the National Institutes of Health, the exact causes of endometriosis are unknown and currently an area of active research. Two potential theories currently under research are:
Retrograde menstruation: This is when endometrial cells back up through the fallopian tubes and into the pelvis during menstruation.
Coelomic metaplasia: This is when cells that line the organs in the pelvis mutate into endometrial tissue.
Certain factors seem to be related to endometriosis:Hormones: Estrogen seems to promote endometriosis.
Body structure: Taller than average height and lower than average BMI both may increase the risk of endometriosis.
Genetics: Endometriosis occasionally runs in families.
Endometriosis symptoms
A common primary symptom is endometriosis-associated pain. Symptoms of endometriosis may include:
Chronic pelvic pain
Chronic lower back pain
Painful periods
Painful urination or bowel movements during menstrual periods
Pain during sexual intercourse
Abnormally heavy menstrual flow
Gastrointestinal issues such as diarrhea, constipation during menstrual periods
Infertility
How to treat endometriosis
There are several options for treating the symptoms of endometriosis. Medical treatments can involve nonsteroidal anti-inflammatory medicines (NSAIDs) to target the inflammation and thereby reduce endometriosis-related pain. Combined estrogen/progesterone or progesterone-only hormone therapy has also proven to be helpful with pain management as well as the treatment of heavy menstrual cycles. Narcotic or opiate-based pain medications have not been shown to be helpful or safe for long-term pain management for people living with endometriosis. For those with severe symptoms that do not improve with these medications, surgery may be needed.
Surgery
Several surgical options may be explored depending on the severity of the endometriosis:
Laparoscopic surgery: This is a minimally invasive surgery used to confirm the diagnosis of endometriosis and to remove the endometrial tissue that has spread outside of the uterus. An OB/GYN specialist will make a small incision in the abdomen and insert a laparoscope through the incision. With the help of the laparoscope, the doctor can see into the pelvic area and remove the endometrial growths with low risk of damaging the healthy tissue.
Laparotomy: This is a somewhat more invasive surgical treatment of endometriosis that involves a larger incision into the abdominal cavity to remove the endometrial tissue.
Hysterectomy with oophorectomy: This is complete removal of the uterus and ovaries.
Endometriosis medication
Medications can be taken for the treatment of endometriosis symptoms.
Pain relief
Pain medication can be taken to relieve endometriosis related pain (e.g. pelvic pain). Over-the-counter pain relievers include ibuprofen (Advil), naproxen sodium (Aleve), and other nonsteroidal anti-inflammatory drugs (NSAIDs). Narcotics and opiate pain medications are not considered safe or helpful for the treatment of chronic endometriosis pain.
Hormone therapy
Contraceptives: Combined estrogen and progesterone birth control pills or patches can help regulate hormones resulting in lighter and shorter menstrual flow, which can help reduce endometriosis-associated pain.
Progestin: For people who cannot or prefer not to take estrogen, progestin/progesterone-only products can help stop periods and the growth of endometrial implants, reducing endometriosis pain. This can come in the form of birth control pills that contain norethindrone or as a progestin-containing IUD such as Mirena.
Gonadotropin-releasing hormone analogs (GnRH analogs): These can be taken to stop ovarian hormone production and the growth of endometrial cells, relieving endometriosis pain. Examples include Lupron Depot injection (leuprolide), Zoladex injection (goserelin), and Orilissa (elagolix) oral tablets.
Note that some patients experienced return of endometriosis symptoms after stopping hormone therapy.
How to prevent endometriosis
According to the Office on Women's Health, lowering levels of estrogen in the body might help reduce the probability of developing endometriosis. Estrogen is a hormone that, among other things, signals the body to thicken the uterus lining. The following methods can help lower estrogen levels in the body:
Regular exercise: This can help lower estrogen levels
Avoid high alcohol intake: Alcohol tends to increase estrogen levels
Avoid high caffeine intake: High caffeine intake can increase estrogen levels.
Hormone treatments: Birth control pills can help.
Maintain healthy body weight: excess fat stores estrogen on the body.
When to see a doctor for endometriosis
If you are experiencing any of the symptoms of endometriosis, you should speak to one of our board-certified primary care doctors to discuss treatment options as soon as possible.
To make a formal diagnosis of endometriosis, an in-person exam is required and may involve:
Detailed history
Pelvic exam
Magnetic resonance imaging (MRI)
Laparoscopy
Ultrasound
With a formal diagnosis, you and your doctor can then begin to discuss treatment of endometriosis. Although our board-certified primary care doctors cannot confirm a new diagnosis of endometriosis online, if you already have this diagnosis or suspect you might have it, we can discuss appropriate evaluation and treatment options. We can also provide referrals to a local OB/GYN if needed.
Endometriosis treatment FAQs
What is the best treatment for endometriosis?
Endometriosis treatment can consist of medication, surgery, or both. The best treatment depends on the stage of your endometriosis and how it affects your daily life. For some, hormone therapy and NSAID pain relief medications are enough to reduce endometriosis associated symptoms. For cases where fertility is a concern, surgeries are often needed to remove the abnormal endometrial tissue.
What is the best medication for endometriosis?
The best medication is dependent on the severity of the endometriosis symptoms. Over-the-counter pain relievers such as ibuprofen (Advil), naproxen sodium (Aleve), and similar nonsteroidal anti-inflammatory drugs (NSAIDs) can be taken for pain and inflammation relief. Many people do their best when they combine NSAIDs with hormone treatments. Hormone therapies include contraceptives, progestin, and gonadotropin-releasing hormone analogs.
What does endometriosis feel like?
Many female patients describe endometriosis pain as intense, sharp, and stabbing pain in the lower abdomen and pelvic region. The pain typically starts a few days before the period, lasting for several days.
Can you get pregnant with endometriosis?
Yes, it is still possible to get pregnant with endometriosis.
Is endometriosis genetic?
Endometriosis seems to sometimes be an inheritable trait that runs in families, so genetics do seem to be one of the risk factors. There is currently no test to check for genetic risk.
Can endometriosis kill you?
No, endometriosis is not a fatal condition (even at stage 4). However, the pain can be unbearable and degrades quality of life. If you are experiencing any of the symptoms of endometriosis or severe pain, you should speak to one of our board-certified primary care doctors to discuss treatment options as soon as possible.
3 simple steps to request an endometriosis consultation
Step 1
Book an endometriosis consultation appointment.
Book a same day appointment from anywhere.
Step 2
Talk to your medical provider regarding your endometriosis symptoms.
Visit with a doctor on your smartphone or computer.
Step 3
If prescribed, pick up a prescription for endometriosis treatment.
We can send prescriptions to any local pharmacy and order tests if appropriate to a lab near you. We can also provide a referral to a local OB-GYN if needed.
Related conditions to endometriosis
Fibroids
Fibroids are smooth muscle tumors that grow in the uterus. Fibroids are typically noncancerous. Fibroids and endometriosis can both cause pelvic pain, heavy periods, and reduce fertility.
Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome is a hormonal condition. Specifically, females with PCOS have higher levels of androgens. Androgens are "male hormones" that can interfere with ovulation. Both PCOS and endometriosis have similar symptoms such as heavy menstrual bleeding and reduction in female fertility.
Fibromyalgia
Fibromyalgia syndrome is a disease that causes recurring pain in the muscles, tendons, and ligaments. According to the National Institutes of Health, researchers have found that women with endometriosis are more likely to suffer from fibromyalgia.
Endometriosis consultation pricing details
How pricing works
To request an endometriosis consultation and get a new or refill on your prescription, join our monthly membership and get discounted visits.
Paying with insurance
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$16.99/month
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Visit price with insurance
Often the same as an office visit. Most patients with in-network insurance pay $30 or less!
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Paying without insurance
Membership
$16.99/month
First month free
Visits
$129
30 days of free membership
Same-day appointments 7 days a week
Unlimited messages with your Care Team
Prescription discount card to save up to 80%
Exclusive discounts on lab tests
Free memberships for your family
Cancel anytime
Visit price without insurance
Initial visits are $129.
If we're unable to treat you, we'll provide a full refund.
Endometriosis treatment resources
Sources:
PlushCare is dedicated to providing you with accurate and trustworthy health information.
Womenshealth.gov. "Endometriosis." Accessed 2 Oct. 2023. www.womenshealth.gov/a-z-topics/endometriosis.
Johns Hopkins Medicine. "Endometriosis - Symptoms and Causes." www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis. Accessed 2 Oct. 2023.
Mayo Clinic. "Endometriosis - Symptoms and Causes." Accessed 2 Oct. 2023.https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "NICHD Researchers Identify Key Genes and Regulatory Elements Associated with Endometriosis." Accessed 2 Oct. 2023. https://www.nichd.nih.gov/newsroom/releases/endometriosis
PlushCare content is reviewed by MDs, PhDs, NPs, nutritionists, and other healthcare professionals. Learn more about our editorial standards and meet the medical team. The PlushCare site or any linked materials are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment.