Abhishek Mahajan (narrator / author)

In the former case, the primary strategy revolves around hormonal therapy.

The logic is simple.

Starve the lesions of the chemical cues they need to grow and cycle.

Oral contraceptives are used to flatten the hormonal fluctuations of the menstrual cycle, progestin mimics to induce an atrophic state in the endometrial-like tissue, and, in short doses, GnRH agonists to induce a reversible state of complete estrogen suppression.

There are other treatment paths too, but these are the most commonly used ones.

In the latter cases, usually for endometriosis that is either resistant to hormonal therapy or has progressed to the point of causing anatomical distortion, organ dysfunction, or intolerable pain, direct surgical intervention is used.

The goal is twofold.

Remove or destroy visible lesions, and restore normal pelvic anatomy that have become fused together through endometrial tissue-like overgrowth.

Neither of these do anything to actually cure the disease.

I want to be fair and give the necessary nuance to that statement, because it is a strong one to make, but I want to be clear.

What they both do is management of endometriosis.

But they do not represent a cure in any functional capacity.

In the case of hormonal treatments, the endometrial tissue doesn't starve, not really.

There are cases where hormonal treatments do genuinely reduce the size of a malignant entity, such as in estrogen-dependent breast cancer.

But this is not the case for endometriosis lesions.

One review paper found that while hormonal therapy helps slow progression in some patients, there is minimal evidence of change in the size of endometrial lesions over months of continued therapy.

Moreover, oral contraceptives do not seem to stop the expression of angiogenesis factors within endometrial lesions and may in fact somehow accelerate it.

And if a patient ever stops the hormone therapy, relapse is the norm.

One study found that a majority of patients saw symptom recurrence within five years after finishing a year-long cycle of GnRH agonist therapy.

The case for surgery isn't much better.