Which Hormonal Contraceptives Can Be an Effective Endometriosis Treatment?

Birthcontrol pills
Birth Control for Endometriosis. Flavio Coelho / Getty Images

Endometriosis is a condition in which the tissue that normally lines the inside of the uterus (the endometrium) grows in other areas of the body. It causes pain, irregular bleeding, and possible infertility. Endometriosis is a common problem and probably begins about the time that regular menstruation begins. The Depo-subQ Provera 104 injection has been FDA-approved to help treat the pain associated with endometriosis.

Other hormonal contraceptives may be helpful as well.

Although more than 80% of U.S. women will use hormonal contraception (like the Pill) sometime during their reproductive years, many do not realize the noncontraceptive benefits of using this type of birth control. Hormonal contraceptives contain either progestin, estrogen, or both.

Using Hormonal Contraception to Treat Endometriosis

Some of these contraceptives have shown some ability to diminish endometriosis-related pain. That being said, it is important to note that the main reason to use hormonal contraception is for birth control (to prevent an unintended pregnancy) -- the potential noncontraceptive benefits can be considered when deciding which hormonal birth control method may be best suited for you.

The following is a list of various prescription birth control methods that have been shown to be effective in relieving some of the pain associated with endometriosis:

  • Depo Provera and Depo-subQ Provera 104: Both have been shown to reduce pain caused by endometriosis. The Depo-subQ Provera 104 injection is the first new remedy in the last 15 years to be FDA-approved for the treatment of endometriosis-related pain. According to research provided by Pfizer, the manufacturer of Depo Provera, Depo-subQ Provera 104 treats endometriosis pain as effectively as leuprolide, yet is associated with fewer vasomotor symptoms (like hot flashes or sweats) and significantly less bone loss. In fact, Depo Provera yielded pain relief statistically equivalent to that of leuprolide across all endometriosis-associated areas -- pelvic pain, pelvic tenderness, dysmenorrhea, painful intercourse, and hardening and thickening of tissue.
  • Implanon: This contraceptive implant has also been shown to reduce pain due to endometriosis. Though it is not known precisely how the progestin (etonogestrel) in Implanon helps to relieve the symptoms of endometriosis, it is thought to work by suppressing the growth of endometrial implants, thus causing them to gradually diminish. Progestin may also help reduce the inflammation in the uterus caused by endometriosis (thereby offering some relief from the pain).
  • Mirena: The Mirena IUD has been shown to help in treating the dysmenorrhea and chronic pelvic pain associated with endometriosis -- though it has not been FDA-approved for this use. Given that Mirena can be left in place for up to five years, this IUD offers the potential to be a long-term endometriosis treatment for women who want to postpone pregnancy. Several small clinical trials have investigated the effectiveness of the Mirena IUD for the treatment of endometriosis; this research showed that the Mirena may be helpful in reducing period pain over three years, with most of the improvement being in the first 12–18 months. Mirena is thought to help reduce the amount of blood flow during a woman's period, which may help to reduce endometriosis-related pain. In fact, in women who wish to obtain intrauterine contraception, the Mirena IUD is now FDA-approved to treat heavy periods.
  • Extended Cycle Birth Control Pills: Continuous birth control pills (like Lybrel or Seasonique) may offer an additional benefit of elimination or reduction of periods and associated dysmenorrhea linked to endometriosis. However, there is limited data to suggest that combination birth control pills can reduce the severity of dysmenorrhea in women with endometriosis.

Sources

Jain, J. (2005). "Contraception: Subcutaneous depot medroxyprogesterone acetate for birth control and endometriosis pain". OBG Management, Vol. 17, No 8. Accessed via private subscription.

Lockhat FB, Emembolu JO, Konje JC. "The efficacy, side-effects and continuation rates in women with symptomatic endometriosis undergoing treatment with an intra-uterine administered progestogen (levonorgestrel): A 3 year follow-up." Hum Reprod 2005;20:789–93.

Pfizer. (2005) "Depo-SubQ Provera 104."  http://labeling.pfizer.com/ShowLabeling.aspx?id=549

Pfizer. (2004) "Depo Provera: Contraceptive Injection." http://labeling.pfizer.com/ShowLabeling.aspx?id=522

Schweppe, K-W. "Current place of progestins in the treatment of endometriosis-related complaints." Gynecol Endocrinol 2001;15(S6):22–8.

Sullivan, M. (2005). "New treatment approved for endometriosis pain". OB/GYN News.

Surrey, ES. "The role of progestins in treating the pain of endometriosis." J Min Invasive Gynecol 2006;13:528–34.

Vercellini, P., Fedele, L., Pietropaolo, G., Frontino G, Somigliana, E., Corsignani, PG. "Progestogens for endometriosis: Forward to the past." Hum Reprod Update 2003;9:387–96.

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