What is the first-line treatment recommended for moderate to severe endometriosis?

For moderate to severe endometriosis, hormonal therapy, including combined oral contraceptives, is recognized as the first-line treatment. This approach is effective because it helps to suppress the hormonal stimulation of endometrial tissue, leading to a reduction in pain and progression of the disease. Estrogen is known to promote the growth of endometrial tissue, and by using hormonal therapy to keep estrogen levels in check, the lesions can be managed more effectively.

Additionally, combined oral contraceptives not only help alleviate symptoms but can also regularize menstrual cycles and reduce the intensity of bleeding, which is beneficial for patients suffering from endometriosis. This treatment option is often favored due to its non-invasive nature and the ability to be easily adjusted or discontinued if needed.

In contrast, antibiotic therapy is not indicated as a first-line treatment for endometriosis because the condition is not caused by an infection. Hysterectomy is a more invasive surgical option generally considered for severe cases or when other treatments have failed, rather than as an initial therapeutic strategy. Pain management with over-the-counter medication may provide temporary relief but does not address the underlying issue of endometriosis, nor does it prevent future symptoms or complications.