Birth control hormones (patch, pills, or ring) for endometriosis

Why are they used?

Birth control hormones relieve endometriosis by stopping ovulation and reducing the endometrium's monthly cycle of growing, shedding, and bleeding. They also affect the endometriosis growths (implants), making them shrink and bleed less.¹ Birth control hormones can also be used to stop or further slow endometriosis growths after endometriosis surgery.

You can get birth control hormones as a pill you take by mouth every day, as a weekly hormone skin patch, or as a monthly vaginal ring.

Birth control hormones are the first-choice treatment for controlling endometriosis growth and pain. This is because birth control hormones are the hormone therapy that is least likely to cause bad side effects. For this reason, they can be used for years. Other hormone therapies can only be used for several months to 2 years.

How well do they work?

Like all hormone therapies and surgery, birth control hormones do not cure endometriosis. But they can relieve endometriosis symptoms and are likely to slow the growth of endometriosis.

Birth control hormones improve endometriosis and menstrual pain and bleeding for most women.² They are most effective when used to relieve minimal to mild symptoms.

Continuous use of birth control pills is likely to give the most relief.³ About one-third of women who take regular 28-day cycles have pain during the fourth, hormone-free week. Talk to your doctor about:

• Lybrel, which has an estrogen/progestin pill for every day of the month. This means that you have no monthly periods. (But you may have surprise spotting or bleeding, especially during the first year.)
• Seasonale and Seasonique, which have 12 weeks of estrogen/progestin pills. Seasonale then has a week of no-hormone pills. Seasonique has a week of low-dose estrogen pills. This is the week you might have menstrual bleeding.

Birth control hormones can be used with nonsteroidal anti-inflammatory drug (NSAID) therapy, which helps further reduce endometriosis inflammation and pain-causing prostaglandins.

What else should I know?

Using birth control hormones for 5 or more years lowers ovarian cancer risk (endometriosis increases ovarian cancer risk).⁴

Birth control hormones cannot be used to treat infertility caused by endometriosis. They prevent pregnancy.

Citations

1. Mishell DR Jr, et al. (2001). Endometriosis and adenomyosis. In MA Stenchever et al., eds., Comprehensive Gynecology, 4th ed., pp. 531–564. St. Louis: Mosby.

2. Johnson N, Farquhar C (2006). Endometriosis, search date April 2006. Online version of Clinical Evidence (15).

3. Vercellini P, et al. (2003). Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. Fertility and Sterility, 80(3): 560–563.

4. Modugno F, et al. (2004). Oral contraceptive use, reproductive history, and risk of epithelial ovarian cancer in women with and without endometriosis. American Journal of Obstetrics and Gynecology, 191(3): 733–740.