Question 1

What is usually tried first for endometriosis pain, and how is it chosen?

Accepted Answer

Many start with continuous combined hormonal contraceptives or a progestin (such as norethindrone acetate or dienogest where available) or natural compounded progesterone; the levonorgestrel IUD is another effective option for pain and heavy bleeding. Selection depends on symptoms, bleeding goals, migraine or clot risk, tolerance of hormones, and whether future fertility is being timed.  It is prudent to obtain a correct diagnosis, which can only be obtained via minimally invasive surgery at this time.

Question 2

Do medications shrink or cure endometriosis?

Accepted Answer

Medicines suppress hormonal stimulation of lesions and reduce inflammation, easing pain and sometimes reducing cyst or lesion activity, but they do not remove disease. Symptoms often return when treatment stops; after excision, ongoing suppression can lower the risk of recurrent pain and endometriosis itself.

Question 3

How do GnRH agonists and antagonists compare, and why use add-back therapy?

Accepted Answer

Both agonists and antagonists lower estrogen to quiet disease; antagonists work rapidly and are oral, while agonists are typically injections with a brief flare before suppression. Add‑back therapy (low‑dose estrogen/progestin or progestin alone) protects bones and reduces hot flashes without meaningfully reducing pain control. Long term therapy is generally not possible due to toxicities and side effects. Even short term treatment with these agents requires extensive risk vs benefit discussion.

Question 4

Can I use medical therapy if I’m trying to get pregnant?

Accepted Answer

Most hormonal therapies prevent ovulation and are paused when actively trying to conceive; they do not improve natural fertility. For symptom control while attempting pregnancy, consider non‑hormonal strategies and coordinate timing with fertility plans through Fertility & Reproductive Health or IVF & ART.

Question 5

What side effects and monitoring should I expect, and how long can I stay on treatment?

Accepted Answer

Progestogens may cause spotting, mood or acne changes; combination pills carry rare clot risk in susceptible patients. GnRH options can affect bone density, liver, the cardiovascular system and subjective factors such as mood.  So add‑back and periodic monitoring are important; many can stay on progestogens or IUDs long term if well‑tolerated, while GnRH regimens are generally time‑limited with follow‑up to protect bone health.

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