Medical Treatments for Endometriosis: Which is Best? Part 1

Hormones are powerful messengers in the body: chemicals made in one area that affect cells in other areas. Estrogen and progesterone are two major hormones that are important in the growth of endometriosis, so they can also be helpful to manage it.

In general, estrogen causes endometriosis cells to grow, and progesterone-type hormones cause them to shrink. (Just as, in general, estrogen causes periods to be heavier, and progesterone makes them lighter). Shrinking the cells can improve pain—though it can take some time. As with all types of treatment, there are pros and cons. And our body’s response to hormones is very individual: something that works great for you may not help your coworker at all.1 So it’s so important to have good communication with your clinician about how things are going as you try a new treatment.

Let’s go through some of the hormonal methods that can help with endometriosis. I’ll start with the most common, birth control pills (and their relatives NuvaRing and the patch), and in Part 2 you can read more about IUDs, DepoProvera, DepoLupron and Orilissa, and progesterone pills.

Birth control pills

If your clinician suspects that you have endometriosis, they may recommend birth control pills as a first step in therapy. The most common birth control pills (BCP) are a combination of a type of estrogen and a type of progesterone. But doesn’t estrogen make endometriosis grow? BCP have relatively more progesterone than estrogen, so they usually shrink endometriosis.

Effectiveness

BCP often help with period cramps, pain between periods, pain with intercourse, and chocolate cysts. When choosing a type of pill, your clinician may recommend a version that has a smaller amount of estrogen. Some BCP create a period only every three months, which can really help with period pain. But they don’t work immediately: it can take a few months before you see an improvement in endometriosis.

Side effects

Some helpful side effects of BCP are lighter periods, less acne and PMS, fewer cysts of the ovary (including chocolate cysts), and less chance of cancer of the uterus, ovaries, and colon.2 And of course, the pill works well to prevent pregnancy, for those who want that protection.

BCP can also cause some annoying side effects, like nausea, breast tenderness, headaches, decreased interest in sex, and bleeding between periods. These are common in the first few months, and usually get better over time. If they don’t improve, your clinician can usually help you find a different pill that will work better for you, so let them know what you are going through.

Risks

BCP do cause a small increase in the chance of having blood clots in veins, heart attack, stroke, and breast cancer.2 These effects are rare. Your clinician will ask you about risk factors for these problems before prescribing, to make sure that the chance of this happening to you is low. For people with these risk factors, like high blood pressure, a blood clotting problem, or being a tobacco smoker over the age of 35, a treatment with no estrogen is a safer choice.3

Nuvaring and the birth control patch have the same hormones as BCP, just delivered to the body in a different way. They work in the same way as BCP. Risks are low and are similar to BCP, but both Nuvaring and OrthoEvra are more likely to cause blood clots (in the lungs, for example) than pills.

Continue on to Part 2 to read about other hormone treatments for endometriosis.

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