Medical Treatments for Endometriosis: Which is Best? Part 2

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Here, Dr. Audrey Sheridan explores hormonal treatment options for endometriosis, including IUDs and DepoProvera.

Intrauterine devices

There are two main types of IUD. One type has no hormones, but is made with copper. This one does not help endometriosis, and can cause heavier and more painful periods. IUDs like Mirena, Skyla, Kyleena and Liletta all release progesterone.

Effectiveness

Mirena is the IUD with the most scientific studies, but the others are very similar. Mirena improves period flow amount and period pain, and even decreases the amount of endometriosis found at surgery.^1-3 It helps with adenomyosis too.

An IUD may take some time to work: pain usually starts to get better within the first few months, and keeps improving for up to 12 months. The relief lasts at least 3 years (if you keep the IUD) and likely up to the 5 years that Mirena can be used. And Mirena (and the others) are very effective at preventing pregnancy.^4,5

Side effects

In the first few months, it’s common and normal to have some irregular, usually light bleeding. This usually gets better after the first few months. Other side effects might be depression, weight gain, acne, headaches, decreased interest in sex, and ovarian cysts- though most people do well with Mirena.

Risks

Ovarian cysts are more common with Mirena. Occasionally the IUD may fall out, and this process can be crampy. Mirena is very effective at preventing pregnancy, but if pregnancy does occur, it is more likely to be an ectopic, or tubal pregnancy. Rarely, the IUD may embed in the uterus muscle, or may perforate (go through) the uterus wall. And yes, it is crampy to have it put in, but usually tolerable. If you have surgery, your surgeon may be able to insert the IUD while you are under anesthesia to prevent endometriosis after surgery.

DepoProvera

This is a shot of progesterone that you get every 3 months. The “Depo” in the name means that it slowly releases its hormone over time.

Effectiveness

Like Mirena, it can make periods light or stop them, and helps endometriosis pain.

Side effects

DepoProvera tends to have side effects like irregular bleeding, weight gain, and depression more often than with Mirena or BCP. Decreased interest in sex can also happen.

Risks

DepoProvera causes loss of bone density over time, so it may be safest to use it for just a few years. The injection takes a long time to wear off, so this may not be a good choice if you want to try for pregnancy soon.

Lupron and Orilissa

Both of these drugs cause the ovaries to stop making hormones, like a temporary menopause. Lupron is a shot (every one, three, or six months), while Orilissa is a pill.

Effectiveness

By decreasing your body’s estrogen, these medications can improve endometriosis symptoms, including period pain, non-period pain, and pain with intercourse.^6-8

Side effects

Because they cause such low hormone levels, they can also cause hot flashes, headaches, and nausea.

Risks

Over time they cause bone density to drop, so are usually used for short periods of time (like 6 months). Clinicians often prescribe some low-dose estrogen to counteract the hot flashes and bone loss that Lupron causes. Endometriosis still improves when this “add-back” estrogen is used.⁹

It’s important to know that Lupron and Orilissa do not necessarily prevent pregnancy, so talk to your clinician about birth control while using these drugs.

Progesterone pills

There are several types of progesterone pills available. The minipill is one version; other examples are Provera, Aygestin, and Megace.

Effectiveness

They can improve period pain and bleeding, as well as non-period pain. Progesterone can help with hot flashes, too.

Side effects

Like the others, these may cause breast tenderness, acne, depression, headaches, and decreased interest in sex. Irregular bleeding, usually light, is more common with the minipill than with standard BCP. These pills don’t have the placebo (sugar pill) week like regular BCP, so your period may not be as predictable.

Risks

Serious risk are low with progesterone pills. The minipill does prevent pregnancy, but it’s most effective if you take it very regularly, at the same time every day.

Other hormone therapies: Less common hormonal treatments include danazol, anastrazol, and mifepristone. Your clinician may suggest these when other therapies have not helped.¹⁰

Hormone-based treatments can really improve endometriosis symptoms for many people, and can help slow the return of endometriosis after surgery. As with all therapies, it’s a matter of balancing helpful effects with negative ones. Hormones are powerful, and every body responds differently them—but most people can find a type that works well for them. Remember that it may take some time before you start feeling better. If you have severe side effects, like bad headaches or heavy bleeding, don’t ignore it, and get medical advice right away. Stay in good communication with your healthcare provider to adjust your treatment as needed to find what’s best for you.