Endometriosis is a painful condition that can lead to infertility. There is no cure except a total hysterectomy, but hormones can help considerably with the pain and to prevent it from getting worse.

What is endometriosis? The endometrium is the tissue that lines the uterus. During each menstrual cycle the endometrium thickens, getting ready for possible pregnancy. If you don’t become pregnant, the endometrium is shed, which causes your menstrual period. Endometriosis is endometrial tissue that flows the wrong way out through the fallopian tubes and grows on the ovaries, fallopian tubes, the outer surface of the uterus, bowels or other abdominal organs. The growths are called implants. These implants grow, bleed, and break down with each menstrual cycle, just like the endometrium does. This can cause pain, infertility, and in some cases, scar tissue that interferes with an organ’s normal function. Women who suffer from endometriosis will often feel less pain during pregnancy and have no symptoms at all after menopause.

What can hormones do to help? Hormone therapy can reduce the estrogen levels in your body.  Estrogen is the hormone that “feeds” endometriosis growth. Using progesterone, a Mirena IUD or birth control pills (a estrogen/progestin combo) can slow or halt growth of implants. Let’s take a closer look at each option:

1. progesterone-Using progesterone lowers estrogen levels. This causes the implants to shrink thereby reducing pain as well. Using bioidentical progesterone can be an effective long-term treatment as it helps prevent bloating, protects bones and protects you from breast and uterine cancer. Progesterone has the smallest amount of side affects of any hormone treatment for endometriosis. Does not prevent pregnancy.
2. Mirena IUD- This is a device that releases low levels of progestin constantly into the body and only needs to be changed every 5 years. This is a good option for those who don’t want to think about using a medication daily. Prevents pregnancy. Is a synthetic progestin, but at a very low dose. Side effects can include minor weight gain.
3. Birth control pills-estrogen/progestin combination pills that stop ovulation and endometrial growth. Birth control pills cause implants to shrink and protect against pregnancy.  Lower ovarian cancer risk (which is higher with endometriosis) and can be used long-term.

Hormone therapies are effective for 80-90% of women with endometriosis. While one may work for you, it may not work for someone else. Ultimately, if you are done with childbearing the only definitive cure for endometriosis is hysterectomy with removal of the ovaries that secrete estrogen and feed the implants. This is a last resort for severe pelvic pain. Your physician can help you decide which treatment is right for you.