Birth control pills for endometriosis
|Generic Name||Brand Name|
|estrogen/progestin combination pills (birth control pills)||Brevicon, Demulen, Levlen, Levora, Lo/Ovral, Modicon, Nelova, Nelova 10/11, Nordette, Norethin 1/35E, Norethin 1/50M, Norinyl, Ortho-Novum, Ovcon, Tri-Levlen, Tri-Norinyl, Triphasil, Seasonale [extended cycle]|
Estrogen/progestin combination pill schedule
Use one of the following methods:
- Beginning on the fifth day of your menstrual period, take one tablet daily for 20 or 21 days. This is followed by 7 or 8 days of no medication (you may take sugar pills provided in the pack), during which you have a menstrual period. You then start a new pack of pills.
- For Seasonale, take the active hormone pills continuously for 3 months. This is followed by 7 days of sugar pills. You then start a new pack of pills. If you have bothersome breakthrough bleeding during the 3 months, your health professional may prescribe extra estrogen.
If you prefer, you can use a weekly hormone skin patch or monthly vaginal ring instead of daily pills.
How It Works
Birth control pills (oral contraceptives) that contain estrogen and progestin are also called "the Pill." Birth control pills relieve endometriosis by stopping ovulation and decreasing the endometrium's monthly cycle of growing, bleeding, and shedding. They also affect the endometriosis growths (implants), making them shrink and bleed less.1
Why It Is Used
Birth control pills 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, while other hormone therapies can only be used for several months to 2 years.
Birth control pills can also be used to stop or further slow endometriosis growths after endometriosis surgery.
How Well It Works
Like all hormone therapies and surgery, birth control hormones do not cure endometriosis. However, they can relieve endometriosis symptoms and are likely to slow the growth of endometriosis.
Birth control pills 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 for 84 days (sold as Seasonale) 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.
Using birth control hormones for 5 or more years lowers ovarian cancer risk (endometriosis increases ovarian cancer risk).4
Oral contraceptives cannot be used to treat infertility caused by endometriosis. They prevent pregnancy.
- Per year, up to 20% of all women treated will have pain that returns after hormone treatment.
- About 37% of women who use hormone therapy for mild endometriosis have pain 5 years later.
- About 74% of women who use hormone therapy for severe endometriosis have pain 5 years later.
Side effects from oral contraceptives are usually mild. They may include:
- Changes in menstrual periods, including very light or skipped periods.
- Slight bleeding between periods (spotting). This is more common with an extended cycle (Seasonale) but decreases after 3 to 4 months of use.
- Nausea and vomiting, especially during the first month of use. This side effect usually goes away after the first few months of use.
- Frequent or more severe headaches. Migraine headaches may get worse; for some women, they improve.
- Weight gain.
- Breast tenderness for the first few months of use.
- Depression or mood changes.
- Darkening of the skin on the upper lip, under the eyes, or on the forehead (chloasma) after sun exposure. This may slowly fade after you stop using hormonal methods, but in some cases, it is permanent.
- Decreased interest in sex.
Possible long-term side effects of extended-cycle hormones have yet to be studied.6
Report any of these side effects to your health professional at your next regularly scheduled visit.
Rare but serious side effects
The following symptoms, called ACHES, are rare but serious and should be reported to your health professional immediately. The risk of serious side effects increases in women who smoke and are older than 35.
- Abdominal pain that is severe or persists may be a sign of blood clots (thrombophlebitis) in the pelvis, liver blood clots or tumors, or gallbladder disease.
- Chest pain may be a sign of blood clots in the lungs (pulmonary embolism), heart attack, or heart disease. Smoking increases this risk.
- Headaches that are severe may be a sign of stroke, migraine, or hypertension. Smoking increases this risk.
- Eye problems, such as blurred vision or loss of vision, may be a sign of migraine, blood clots in the eye, or a change in the shape of the cornea.
- Severe leg pain or sudden swelling of one leg may be a sign of leg blood clots (thrombophlebitis) or deep vein thrombosis (DVT).
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
There is no cure for endometriosis. However, birth control hormones may slow the long-term growth of endometriosis. Like all hormone therapies and surgery for endometriosis, birth control hormones do not reduce symptoms in all women.
If you do not smoke and have no other risk factors, you can use birth control pills until menopause. Endometriosis will naturally improve when your estrogen levels drop after menopause.
Oral contraceptives generally are not recommended if you have any of the following risk factors for complications:
- Smoker older than 35
- Uncontrolled diabetes
- Uncontrolled high blood pressure
- Liver disease
- History of blood clots in a vein (deep vein thrombosis) or lung (pulmonary embolus)
- History of stroke
- History of breast cancer
- History of migraine headaches with aura
- Lobo RA. (2007). Endometriosis. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 473–499. Philadelphia: Mosby Elsevier.
- Johnson N, Farquhar C (2006). Endometriosis, search date April 2006. Online version of Clinical Evidence (15).
- 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.
- 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.
- Speroff L, Fritz MA (2005). Endometriosis. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 1103–1133. Philadelphia: Lippincott Williams and Wilkins.
- Abramowicz M (2004). Seasonale. Medical Letter on Drugs and Therapeutics, 46(1175): 9–10.
Last Updated: July 28, 2009
Author: Sandy Jocoy, RN