What is the best pain reliever for endometriosis?

The painkillers do not treat the endometriosis. The painkillers help with the symptoms or some of the symptoms of endometriosis. I think this is very clear. So what we need to be sure is that we make that a clear distinction to our patients. There are some painkillers that may not be indicated for treating endometriosis especially if they can increase the risk of constipation bowel problems which will add to pelvic pain symptoms. So, I think, pain relief is a way to control the symptoms in women with endometriosis and not all pain and relief medications work for every patient. What I normally say to my patient is if you have some significant pain associated with your endometriosis and then ideally you want to have surgical management. If you are known to have endometriosis you want to control the endometriosis as a disease then perhaps consider taking the hormonal birth control pill or taking some injections that could put the body into a sort of artificial menopause and reducing the estrogen levels and stopping menstruation and ovulation. If you have symptoms such as pelvic pain, painful periods, painful ovulation, I think the most common pain medications are the non-steroidal anti-inflammatory. Over-the-counter, certain inflammatories include the ibuprofen, the naproxen and these can be taken but the thing is we need to be sure that we are not recommending the painkiller or pain relief and management as a way to treat the endometriosis.

It could be simple paracetamol or non-steroidal, anti-inflammatory drugs like ibuprofen or mefenamic acid which could relieve the pain and give symptomatic relief and improve the quality of life but there could be the oral contraceptive pill. Obviously back to back, continuous use could also relieve the pain because it controls the symptoms of the disease as well as stops the progression of the disease as well. There could be some injections as well in the form of gonadotrophin releasing hormone agonists which can create sort of menopausal, temporary menopausal condition and that can stop the progression of the disease and improve the symptoms.

There are myths of treatment of endometriosis. What we used to do as gynecologists, if we suspected endometriosis, we would start with painkillers – non-steroidal ibuprofen medications or any non-steroidal medication if it’s mild endometriosis and this painkiller can just increase and accelerate, start to be opiates, morphia or now the research on cannabinoids medication because of the oils, there are some theories that it can suppress the endometriosis but the only problem with this is the side effect: increasing the bloating, increasing the bowel symptoms and it could be very devastating when you stop it -you have the symptoms again. So, it’s not just a real treatment where it can cure you.

The first line treatment for pain recommended by the nice guidance in the UK is a non-steroidal anti-inflammatory drug and the commonest one is ibuprofen. You can buy that over-the-counter and recommend it to patients with suspected endometriosis that they trial for a period of up to three months to see if it’s helpful. The rationale for that is obviously it’s analgesic it provides pain relief but also it’s anti-inflammatory and we know that endometriosis is an inflammatory condition.

Yes, so we recommend different types of painkillers. Because as I said, it’s an inflammatory process, it’s a reaction of the body to the implants of endometriosis inside the body so, anything anti-inflammatory they will be helpful, for example, ibuprofen, many types of anti-inflammatory drugs will be helpful. This is a the simple painkillers, we also advise hormonal therapy for endometriosis so, hormonal therapy will be anything which suppresses ovarian function and stops periods will be really beneficial for endometriosis but these medications when we offer them, we have to make sure that the lady is not planning for a pregnancy because these are actually contraceptives, for example, the combined pill, the progesterone only pill, the depo-provera injection, the implant which is also progestational contraceptive, the merina which is a medicated type of coil which has also progesterone. All these medications are contraceptives and sometimes we offer to stop the ovaries from working in order to suppress the endometriosis by an injection, we call it gonadotrophin releasing hormone analogue which stops the ovaries. We cause a condition like pseudo menopausal status just for the endometriosis to regress and for the ladies pain and symptoms to improve. These options cannot be considered in a lady who’s trying for a baby, of course and so these are the main medications and we offer so, either non-steroidal anti-inflammatory or hormonal therapy. So, the lady is trying for a baby. Of course hormonal therapy will not stand and we always offer laparoscopic or I mean surgical management.