Hormonal birth control is one of the treatment options for endometriosis. Some people find it can relieve pain, and it may reduce the growth of lesions.

Endometriosis causes tissue that usually grows inside the uterus to grow elsewhere, such as around the bladder and intestines. This creates lesions. With each menstrual cycle, this tissue swells and then breaks down, causing significant pain.

Birth control is one type of hormonal therapy that doctors can prescribe for endometriosis. It is often the first-line treatment and works best in people who do not have severe symptoms.

Read on to learn more about birth control for endometriosis, including how it works, the types available, and how long it takes to work.

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Hormonal birth control helps with endometriosis by reducing the production of hormones that regulate ovulation and periods. This may help control symptoms in several ways, by:

  • making periods lighter and shorter
  • decreasing the growth of endometrial tissue outside the uterus
  • reducing inflammation related to the menstrual cycle
  • altering someone’s perception of pain

Hormonal contraceptives stop the menstrual cycle from working as it usually does. Typically, a person ovulates halfway through their cycle. After this, the lining of the uterus grows and swells. If a person does not become pregnant, it breaks down.

Hormonal birth control can stop the hormones that cause this from fluctuating, often preventing ovulation entirely. It cannot remove existing lesions or adhesions, but it may prevent new ones from forming.

However, according to a 2021 review, around one-third of people with endometriosis do not respond to hormonal birth control. This is because some people do not tolerate these medications. Another possible explanation is progesterone resistance, which is a fairly new medical concept.

If this happens, doctors can try other types of endometriosis treatment.

Birth control affects people in different ways, so there is no best type that will suit everyone. The type a person tries can depend on their unique circumstances. Here are some things to consider.

Combined vs. progesterone-only

There are two broad types of hormonal birth control. The first involves a combination of estrogen and progesterone, while the second only includes progesterone. Progesterone-only options can stop periods from happening entirely.

A 2018 systematic review found that both combined and progesterone-only types were significantly better than a placebo at reducing painful periods for those with endometriosis. Both also reduced pain that was not related to menstruation. No evidence suggested that one type was better than the other.

Some people cannot take estrogen-containing medications, so it is important to discuss any other health conditions with a doctor.

Format

Hormonal contraceptives are available in many formats. People can get combination products in pills, patches, and vaginal rings. Progesterone-only products are available as pills, injections, implants, and intrauterine devices (IUDs).

The type a person chooses can depend on several factors, such as their personal preference, lifestyle, and any effects they experience. For example, a person who often forgets to take a pill may prefer something that requires less maintenance.

Schedule

Usually, a person using a combined pill takes one daily for 21 days, then has a break. During this time, people experience a withdrawal bleed that is similar to a period.

Other types of birth control, such as the implant, involve no break. They release hormones continuously. It is also possible to take several birth control pill packs without a break if a doctor says this is OK.

Polycystic ovary syndrome (PCOS) causes high levels of androgen hormones, which are the male sex hormones. Hormonal birth control is one of the treatment options for this condition, too, so a person may find that hormonal birth control helps with both PCOS and endometriosis.

However, some types of birth control can increase androgen levels, which may not be helpful for people with PCOS. A doctor may recommend a combined contraceptive or progesterone-only options that are not androgenic.

For endometriosis relief, it usually takes around 3–6 months before people can tell if birth control is helping, according to the National Institute for Health and Care Excellence. However, people may start to feel improvements before this point.

If birth control is not helping to reduce endometriosis symptoms, a doctor can recommend other treatments.

Not everyone experiences side effects from birth control. The potential side effects that can happen vary slightly depending on the type of contraceptive. People may experience:

  • irregular bleeding
  • headaches
  • nausea
  • bloating
  • breast tenderness
  • mood changes

Progesterone-only medications may also cause weight changes, hair loss, acne, or a low sex drive. Sometimes, these side effects diminish after the first few months. In other cases, people may need to try different types until they find one that suits them.

There are other treatment options for endometriosis, including:

  • over-the-counter pain medications, which people can take alongside hormone therapy
  • gonadotropin-releasing hormone (GnRH) agonists or antagonists, such as leuprorelin (Lupron) or elagolix (Orilissa)
  • aromatase inhibitors, which lower estrogen production
  • Danazol, which doctors prescribe for severe symptoms
  • surgery, such as laparoscopy to remove lesions

Hormonal birth control can be an effective treatment for many people with endometriosis. Although it cannot cure the condition, it can prevent the growth of new lesions, provide pain relief, and regulate the menstrual cycle.

There is no best option that works for everyone, so a person may need to try several types to find one that suits them. If hormonal birth control does not appear to help, a doctor can provide information on the other treatment options available.