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Endometriosis: Should I Use Hormone Therapy?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Endometriosis: Should I Use Hormone Therapy?
Get the facts
- Use hormone therapy.
- Don't use hormone therapy. Take nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain if your doctor says it's okay.
This decision aid is for women who have mild symptoms and have not yet had laparoscopic surgery to diagnose or treat endometriosis. Hysterectomy and oophorectomy may be an option for women who have severe symptoms and have already tried hormone therapy and laparoscopic surgery.
Key points to remember
- There is no cure for endometriosis. But hormone therapy can help relieve pain. Hormones work for up to 90 out of 100 women. This means that they don't work for 10 out of 100 women.1, 2
- Hormone therapy is a good first choice for treatment, unless you want to get pregnant soon. Hormones may reduce the number and size of growths (implants) and keep them from spreading.
- When your menstrual periods stop at around age 50 (menopause) and your estrogen levels drop, endometriosis growth and symptoms will probably also stop. (In some cases, scar tissue remains after menopause and can cause problems.)
- Several hormones may be used. You would start with birth control hormones (such as a patch, pills, or a ring). They are usually the best choice for long-term use until menopause. If they don't help your symptoms, you could move to a stronger hormone. And if that one didn't help, you might try an even stronger hormone. The stronger hormones are often used only for a short time, because they have serious side effects.
- You can take anti-inflammatory medicine with or without hormone therapy to help your pain if your doctor says it's okay.
- For some women, hormones reduce pain for only a short time. For others, relief lasts a long time.
The endometrium is the tissue that lines the uterus. During each menstrual cycle, a new lining grows, getting ready for a possible pregnancy. If you don't become pregnant during that cycle, the lining sheds. This is your menstrual period.
Endometriosis (say "en-doh-mee-tree-OH-sus") is the growth of this tissue outside of the uterus, usually on the ovaries or the fallopian tubes. It also may grow on the outside surface of the uterus, the bowels, or other organs in the belly.
These growths are called "implants." They grow, bleed, and break down with each menstrual cycle, just like the lining of the uterus does. In some women, this can cause pain and can make it hard to get pregnant.
Sometimes scar tissue forms around implants. This also can cause pain and trouble getting pregnant.
The female hormone estrogen, released by the ovaries, makes the implants grow.
While some women never have symptoms, others have severe pain. In some cases, the problem can affect how well your bowels, bladder, or other organs work.
Pain from implants may be mild for a few days before your menstrual period. It may get better during your period. But if an implant grows in a sensitive area such as the rectum, it can cause constant pain or pain during sex, exercise, or bowel movements.
Symptoms often get better during pregnancy and after childbirth and usually go away after menopause.
You likely will start treatment with birth control hormones. They are usually the safest hormones for long-term use. If they don't help your symptoms, you could take a stronger hormone. And if that one doesn't work, you could try an even stronger hormone. The stronger hormones are used only for a short time, because they have serious side effects.
Hormone therapy reduces estrogen levels in your body. Because of this, you can't use hormone therapy if you want to get pregnant.
- Birth control hormones (such as a patch, pills, or a ring) stop ovulation and the growth of implants. These hormones can be used long-term until menopause.
- Gonadotropin-releasing hormone agonist (GnRH-a) therapy lowers estrogen to the levels women have after menopause. It's usually used for only 3 to 6 months. Women usually take it with a little estrogen and progestin to reduce side effects.
- Progestin lowers estrogen. It shrinks implants and reduces pain. Some forms are used for no more than 2 years because of side effects.
- Danazol lowers estrogen levels and raises male hormone (androgen) levels. It shrinks implants and reduces pain for most women. But its side effects make it a last-choice treatment. It's used for no more than 6 to 9 months.
- Aromatase inhibitors help stop the body from making estrogen. These medicines are used along with hormone treatment.
Hormones relieve the symptoms of endometriosis for up to 90 out of 100 women. This means that they don't work for 10 out of 100 women.1, 2 You may have to try two or more types of hormones before you find one that works for you.
If taking birth control hormones works for you, you can use them for years (unless you plan to get pregnant).
For some women, hormones work for a while. For others, relief lasts a long time.
After treatment with any hormone therapy, pain may come back.2
- Each year, pain comes back after treatment for up to 20 out of 100 women who take hormones. This means that pain doesn't come back in 80 out of 100 women who use hormones.
- About 37 out of 100 women who use hormones for mild endometriosis have pain 5 years later. This means that 63 out of 100 women don't have pain 5 years later.
- About 74 out of 100 women who use hormone therapy for severe endometriosis have pain 5 years later. This means that 26 out of 100 women don't have pain 5 years later.
These medicines have different side effects and risks. Some of them can make you feel like you're going through menopause.
- Birth control hormones. Side effects are usually mild and often go away after the first few months. They can include spotting between periods, nausea, headaches, breast tenderness, and mood changes. There is a small increase in the risk of getting blood clots. Your doctor will not prescribe these hormones if you have had blood clots before, have had breast cancer, or are older than 35 and smoke.
- Gonadotropin-releasing hormone agonist (GnRH-a). Side effects can include hot flashes, mood swings, vaginal dryness, less interest in sex, trouble sleeping, and headaches. Risks also include bone thinning.
- Progestin. Side effects may include mood changes and depression, bloating and weight gain, weight loss, breast tenderness, and absent or light and irregular periods. High-dose progestin can cause bone thinning after 2 years of use.3 Talk to your doctor about whether the progestin intrauterine device (Mirena) might give you the same benefits with fewer side effects.
- Danazol. Side effects include decreased breast size, acne, and more facial and body hair. It can also cause deepening of the voice, which can be permanent. It can increase the risk of "bad" cholesterol and the risk of ovarian cancer.
- Aromatase inhibitors. They can cause headaches, nausea, diarrhea, aching joints, and hot flashes. You also have a risk of bone thinning if you use these medicines for a long time.
Your doctor may advise you to try hormones if:
- Your symptoms are mild.
- You are close to menopause. Hormones might ease your symptoms until menopause.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You take hormones as long as your doctor suggests. Depending on the hormone, you may take pills, use a patch, use a vaginal ring, use a nasal spray, or give yourself shots.
- You may have tests to check for side effects, such as high cholesterol, depending on which hormones you take.
- You may take nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen or naproxen, for pain.
- Your symptoms may get better or go away.
- You may be able to take hormones until menopause, when your symptoms should go away.
- Hormones might not relieve your pain, or the pain could return after you stop taking the medicine.
- Hormones have side effects that can include menopause symptoms, rapid bone loss, and an increase in cholesterol.
- You could have side effects from NSAIDs used for pain.
- You may take NSAIDs, such as ibuprofen or naproxen, for pain.
- You may have laparoscopic surgery instead, especially if you can't take hormones or you have fertility problems because of endometriosis.
- You won't have side effects from hormones.
- You can start trying to get pregnant sooner.
- Your symptoms could continue or get worse.
- If you have laparoscopic surgery, you have the risk of infection, bleeding, and damage to your bladder or bowels.
- You could have side effects from NSAIDs used for pain.
Personal stories about treating endometriosis with hormone therapy
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
The pain before and during my periods was so bad, I couldn't exercise. I am an active person, and the pain was really getting me down. I have had endometriosis for years and have tried ibuprofen and other medicines I could get at the drugstore, but they were not helping anymore. My doctor said taking birth control pills might help me. She said that also taking ibuprofen around the time of my period could really help. After a couple of months, I noticed enough of an improvement that I could do everything I used to. I'm especially happy that I can use this treatment for a long time, unlike other hormone therapies like Lupron.
Maria, age 45
I first noticed that my periods were becoming painful about a year ago. I wasn't too concerned, but I discussed the pain with my doctor when I went for a Pap smear. My examination and Pap smear were fine. My doctor said that endometriosis could be the cause of my pain. Since my mom and an older sister have had endometriosis, I wasn't too surprised. My doctor talked to me about my options. She told me that using ibuprofen, such as Advil or Motrin, might help my pain. Now I start taking ibuprofen the day before my period begins. It really helps relieve my pain. As long as ibuprofen helps my pain, I will wait before I try other treatment for my endometriosis.
Kathleen, age 38
I was surprised when my doctor told me endometriosis could be the cause of the pain I was having with my periods. I had never heard of endometriosis before. He explained what it was and told me about the treatments I could try. Taking birth control pills didn't help, and my doctor said a medicine called Lupron might stop the pain, though I could only take it for a few months. Treatment with Lupron worked. I hardly have any pain now, and taking a little estrogen for add-back therapy controlled the hot flashes without feeding the endometriosis.
Hannah, age 29
My periods were really painful about 5 years ago. I went to my doctor, and he asked a lot of questions about my periods and did a pelvic examination and some tests. When all the tests came back normal, he said endometriosis might be the cause of my pain. I asked if waiting a few months to decide about treatment would be dangerous. He said waiting would be fine. After a few months, the pain eased up. I am glad I decided to wait and see.
Nancy, age 40
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to use hormone therapy
Reasons not to use hormone therapy
I want to control my pain better.
I get enough pain relief from anti-inflammatory medicines.
I don't want to wait until menopause for my pain to go away.
I want to wait as long as I can before I start using hormones.
I can handle the side effects of hormones for a few months.
I don't want to deal with the side effects of hormones even for a few months.
I want to have a baby, but I'm willing to put off trying to get pregnant for 6 months or a year.
I want to get pregnant in the next year.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Using hormone therapy
NOT using hormone therapy
What else do you need to make your decision?
Check the facts
Hormone therapy is a good first choice to treat endometriosis if I don't plan to get pregnant soon.
- TrueYou're right. Hormone therapy is a good first choice for treatment, unless you want to get pregnant soon. Hormones may reduce the number and size of growths (implants) and keep them from spreading.
- FalseSorry, that's not right. Hormone therapy is a good first choice for treatment, unless you want to get pregnant soon. Hormones may reduce the number and size of growths (implants) and keep them from spreading.
- I'm not sureIt may help to go back and read "Key points to remember." Hormone therapy is a good first choice, unless you want to get pregnant soon. Hormones may reduce the number and size of implants and keep them from spreading.
Some hormones can cause side effects that will make me feel like I'm going through menopause.
- TrueThat's right. Some hormones just cause mild side effects. But some strong hormones can give you symptoms like those of menopause, such as hot flashes and vaginal dryness.
- FalseNo, that's not right. Some hormones just cause mild side effects. But some strong hormones can give you symptoms like those of menopause, such as hot flashes and vaginal dryness.
- I'm not sureIt may help to go back and read "What are the risks of taking these medicines?" Some hormones just cause mild side effects. But some strong hormones can give you symptoms like those of menopause.
I can take hormone therapy as long as I want to without side effects.
- TrueNo, that's wrong. Birth control pills have side effects but are safe for most women for long-term use until menopause. But other hormones should be used for only a few months or a couple of years because of side effects.
- FalseYou're right. Birth control pills have side effects but are safe for most women for long-term use until menopause. But other hormones should be taken for only a few months or a couple of years because of their side effects.
- I'm not sureIt may help to go back and read "How do you take hormone therapy?" Birth control pills have side effects but are safe for most women for long-term use. But other hormones should be taken for only a few months or a couple of years.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Adam Husney, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|
- Ferrrero S, et al. (2010). Endometriosis, search date December 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Fritz MA, Speroff L (2011). Endometriosis. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1221–1248. Philadelphia: Lippincott Williams and Wilkins.
- U.S. Food and Drug Administration (2004). Depo-Provera contraceptive injection (medroxyprogesterone acetate injectable suspension). Safety Alerts for Human Medical Products. Available online: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm154784.htm.