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

Many patients start with hormonal suppression to reduce the cycle-driven inflammation and bleeding that can fuel endometriosis symptoms. Common first-line options include continuous combined hormonal contraception, a progestin-only medication, or a levonorgestrel IUD—chosen based on whether your main problem is pain, heavy bleeding, or both.

The “best” first step is individualized: we consider your bleeding goals, migraine history, clot risk factors, prior side effects with hormones, and whether you’re trying to conceive now or planning fertility timing. If symptoms persist or the picture is unclear, our team can help clarify whether endometriosis, adenomyosis, or another pelvic pain condition is most likely and map out next steps. Because imaging and symptoms alone can be misleading, definitive diagnosis is made by direct visualization and tissue confirmation during minimally invasive surgery, and we can discuss when that becomes appropriate in your situation.