Which medication can be used before a definite diagnosis of endometriosis?

When the doctor suspects a woman to have endometriosis related pain, the patient and the doctor can decide that without a definite diagnosis (made by a laparoscopy) the pain is treated as if the patient has endometriosis. This is called empirical treatment or treatment without a definitive diagnosis.

For painful symptoms suspected to be caused by endometriosis, empirical treatment includes analgesia, hormonal contraceptives or progestagens.

Since GnRH analogues have considerable side effects and are very expensive, doctors and patients should consider not using this type of drugs for empirical treatment.

Can I take analgesics (painkillers) for
pain due to endometriosis?

It is important to note that there is little or no evidence for the use of specific analgesics (and other medications for pain) in those living with endometriosis. The evidence is assumed from historical use and studies for other conditions. The lack of trials and strong evidence means that there is no guidance. It may take some trial and error to find a plan that works for you. Your GP and Pain Management Consultant can work with you to achieve a pain management plan.

Analgesics, like paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), are medical therapies that influence how the body experiences pain. These medications are not specific for endometriosis related pain, and they do not have any impact on the endometriosis lesions.

The ESHRE Endometriosis guideline development group recommends that clinicians should consider NSAIDs or other analgesics to reduce endometriosis-associated pain. They are a cost-effective and relatively safe first-line treatment in the management of endometriosis symptoms.

Non-Steroidal Anti Inflammatory drugs (NSAIDs)

NSAIDs are a type of pain medicine that can help to relieve the inflammatory pain caused by endometriosis. These drugs work by stopping the release of prostaglandins, one of the main chemicals responsible for pain in general as well as painful menstrual periods. NSAIDs need to be taken one to two days before your period to prevent prostaglandin production and therefore reduce pain. It may take some time, and several doses, for the NSAIDs to block the prostaglandin production and reduce pain. NSAIDs do not shrink or prevent the growth of endometriosis. Examples of NSAIDs in Ireland are Ibuprofen, Ponstan, Naproxen, Difene.

NSAIDs can have some serious side effects that include gastrointestinal bleeding, stomach upset, kidney problems, and high blood pressure. If you are taking an NSAID such as ibuprofen or naproxen, you should take them with or after food, because NSAIDs can irritate the lining of the stomach and sometimes cause bleeding.

Your doctor may prescribe a tablet called a proton pump inhibitor (PPI) to help protect the stomach if they feel you are at risk from an NSAID, or if you need to take them for long periods. Speak to your doctor to be sure they are suitable for you.

Paracetamol (Acetaminophen)

Paracetamol works as a painkiller by blocking the production of prostaglandins, making the body less aware of the pain or injury.

Paracetamol reduces temperature by acting on the area of the brain that is responsible for controlling temperature. Paracetamol is a commonly used pain killer, but recent reviews on Cochrane questioned its effectiveness. Paracetamol can be taken with NSAIDs to help manage pain. Paracetamol can have serious side effects if the dose is exceeded. Side effects of paracetamol include a rash, thrombocytopenia (low platelet count) and leukopenia (low number of white blood cells), liver and kidney damage when taken at higher-than-recommended doses. Speak to your doctor to be sure it is suitable for you. Be aware that many over the counter remedies for colds / flu and period pain contain paracetamol.

Paracetamol / Opioid Combined Medications

Co-codamol / Co-dydramol are pain killing drugs is sold over the counter in a low dose with limitations (Solphadine) and is prescribed in higher doses under (Kapake, Solpadol). It is a combination of two drugs – paracetamol and codeine. Doctors often prescribe it to relieve pain after surgery. It is a treatment for moderate pain.

Paracetamol controls pain by blocking prostaglandins. Codeine is a type of opioid. Opioids work by mimicking the body’s natural painkillers, endorphins. They control pain by blocking pain messages to the brain. There are different types of opioids – strong ones and weak ones. Codeine is a weak opioid.

Side effects of Co-codamol include nausea, constipation, drowsiness, sweating, dizziness, dry mouth.

Opioid Medications

Opioid painkillers are prescribed for moderate to severe pain, but physical or psychological dependence and tolerance is a risk if taken regularly.
Therefore, your doctor will not prescribe opioid painkillers to you over long periods of time without regular medical review. Working closely with your GP and pain specialist can help tailor a specific plan for your pain.

Opioids work by binding to certain receptors in your central nervous system, your gut and other parts of your body, and this leads to a decrease in the way pain is felt as well as any reaction to pain.
The most common side-effects of opioids are nausea and vomiting - particularly at the start of treatment – constipation, a dry mouth, drowsiness and confusion.