Hormonal treatments are often the first-line therapy recommended for endometriosis, but they may not be suitable for everyone. Nonhormonal treatments may work as an alternative and provide symptom relief.

While there is no cure for endometriosis, it’s possible to manage and treat symptoms without hormones. Nonhormonal treatments for endometriosis range from different medications to lifestyle changes and surgery.

However, the benefits of nonhormonal treatments are less defined. In most cases, the safety and efficacy haven’t been verified by large clinical trials.

It’s important to keep in mind that the same strategies won’t work for everyone. You may need to try several types of endometriosis treatments before finding an effective treatment option.

Nonhormonal medications may have the potential to lessen endometriosis lesions and reduce symptoms. Currently, no nonhormonal medications are specifically approved for endometriosis treatment, though several hold promise.

Common examples of nonhormonal medications that may help with endometriosis symptoms include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen (Advil) and naproxen sodium (Aleve), can reduce pain and inflammation associated with endometriosis. While NSAIDs are a good first-line treatment of symptoms, some aren’t recommended for long-term use due to possible side effects.
  • TNF-alpha antagonists: Anecdotal reports suggest that TNF-alpha blockers may help with endometriosis. However, further research is needed. They may be beneficial due to their ability to reduce friction during digestion. More studies are needed to confirm their benefits. These drugs include:
    • Pentoxifylline: Its anti-inflammatory properties could reduce inflammation and relieve endometriosis pain. It has strong potential for clinical use.
    • Etanercept (Enbrel): Currently used for autoimmune conditions, there is potential for etanercept to reduce fertility challenges in people with endometriosis, but more studies are needed.
    • N-palmitoylethanolamine (N-PEA): This drug may be helpful for treating chronic pelvic pain, but higher quality studies are needed.

Nutritional interventions may help prevent and possibly treat endometriosis pain. While there aren’t specific endometriosis-related diet recommendations to follow, you may find symptom relief by consuming the following:

  • Fiber: Increasing dietary fiber has been shown to reduce circulating estrogen by 10% to 25%, which can reduce endometriosis symptoms. Good sources of fiber include whole grains, fruits, vegetables, and legumes.
  • Vitamin D: Found in oily fish and egg yolks, low vitamin D levels are associated with more severe endometriosis symptoms.
  • Iron-rich foods: They may help lower inflammation levels and can be found in foods like dark leafy greens, legumes, nuts, and seeds.
  • Essential fatty acids: Omega-3 fatty acids are associated with a lower risk of endometriosis. They’re found in salmon, trout, sardines, chia seeds, and walnuts.

You may be able to reduce the risk of endometriosis or improve its symptoms by avoiding:

  • Trans fats: Found in many highly processed foods and meat and dairy products, trans fats specifically are associated with an increased endometriosis risk.
  • Red meat: There is a significant correlation between red meat consumption and the risk of developing endometriosis. A 2019 study showed a 56% higher risk of endometriosis in women who ate more than 2 servings of red meat daily. The same results weren’t seen with other types of meat or fish, such as poultry or shellfish.

Physical therapy involves techniques, exercises, and treatments aimed at treating a certain illness or injury.

For endometriosis, physical therapy can be a useful complementary therapy to help reduce your pain and improve your quality of life. Examples include:

  • pelvic floor exercises to support bladder, bowel, and sexual function
  • deep tissue massage to break up scar tissue and reduce pain
  • relaxation techniques such as guided meditation and deep breathing for pain relief
  • visceral manipulation therapy to help with bloating, pelvic pain, and abdominal pain
  • electrical stimulation uses low levels of electricity to help with pain, inflammation, and circulation

Acupuncture is a form of traditional Chinese medicine that involves the insertion of thin needles at various pressure points on the body to relieve pain. For some people, acupuncture treatment can offer relief from endometriosis pain and symptoms.

A 2023 study including 106 women showed that those treated with acupuncture experienced less pain during their periods, though the benefits didn’t continue after treatment stopped. More conclusive studies are needed, but acupuncture is generally considered safe when performed by a licensed professional.

Surgery can be a nonhormonal treatment option for endometriosis when other methods haven’t worked. A healthcare professional may recommend it if endometriosis starts to interfere with other organs.

There are two main types of endometriosis surgery:

  • Laparoscopy: This is the most common endometriosis surgery and the least invasive. Used for mild to severe endometriosis, laparoscopy is usually performed as an outpatient procedure. A surgeon will insert a small scope through an incision in your abdomen. Using the scope, they can then locate and remove any damaged endometrial tissue.
  • Laparotomy: A more invasive surgical option, laparotomy is usually reserved for more severe cases of endometriosis. Here, a surgeon will make a larger incision to examine and remove damaged endometrial tissue. This surgery requires a longer hospital stay and an extended recovery time.

A 2018 study reported that laparoscopy for endometriosis treated pelvic pain and improved the overall quality of life for women with endometriosis. Many of the study participants were also able to stop taking other medications for endometriosis.

Surgery can’t cure endometriosis, and it’s possible for the endometrial tissue to grow back. Up to 80% of people who have endometriosis surgery experience symptoms again within 2 years. However, surgery can be very effective at reducing endometriosis symptoms, and it may also help improve fertility.

CBT is a kind of psychological treatment that can be effective for several issues, including pain management. It focuses on changing negative thought patterns to improve your mental health and quality of life.

While more specific clinical studies are needed, research from 2024 shows that CBT is an effective strategy in reducing the pain of endometriosis symptoms, either alone or used with other treatment methods. CBT strategies can include:

Nonhormonal endometriosis treatments are available, but most may not be as effective as hormonal options.

However, everyone responds very differently to treatments, and some nonhormonal methods may help relieve endometriosis symptoms in some people.