Combination hormonal treatment is very effective for treating endometriosis. Hormonal treatment doesn’t “cure” endometriosis, but it may help with controlling pain by stopping your periods and preventing endometriosis from getting worse. Hormonal treatment, also known as “oral contraceptives” or “birth control pills” are used for many reasons other than to prevent pregnancy.
What exactly are hormonal pills?
Hormonal pills contain the hormones estrogen and progestin, which are similar to the hormones that are normally made by the ovaries. There is also another type of pill that contains only one hormone (progestin), and is called either the “progestin–only pill”, or the “mini–pill”.
Are there different kinds of hormonal pills?
Yes. There are many different hormonal pills that come in a lot of different packages. The shapes and colors of the packages may be different but there are just two categories of pills: combined estrogen and progestin pills (these have both estrogen and progestin hormone medicine in them), and progestin–only pills that contain just progestin. Hormonal pills come in a 21–day pill pack or a 23, 24, or 28–day pill pack. The most common pill packs are the 21–day pack which contain all hormone pills and the 28–day pack contains 3 weeks of hormone pills and 1 week of inactive (placebo) pills. There is no “best” pill for endometriosis.
How do I know if hormonal pills are right for me?
Not everyone should take hormonal pills. You will be asked questions about your medical history, such as whether you or anyone in your family has a history of blood clots. In addition, you won’t be given estrogen pills if you have certain types of migraine headaches. There are different doses of hormones in different hormonal pills. Your gynecologist may prescribe a progestin–only pill if there is a medical reason why you should not take estrogen. Please tell your GYN team if you have migraine headaches or a family history of blood clots or strokes.
Are there other medical benefits of taking hormonal pills?
Yes. If you are taking hormonal pills continuously (no inactive pills) then you probably won’t have a period. Hormonal pills also lower your chance of getting endometrial (lining of the uterus) cancer and ovarian cancer, ovarian cysts, certain breast lumps, and may protect you from osteoporosis. Hormonal treatment can also improve acne.
What is the difference between “active” and “inactive” hormonal pills?
Active pills contain hormone medicine. If your pill pack is in the shape of a rectangle, the pills will be in 4 rows (7 pills in each row). The active pills are in the first 3 rows of your pill pack. The inactive pills are in the last row of the 28–day pill pack and DO NOT contain hormone medicine. If your pill pack is round, the pills will be in a circle. The active pills are the first 21 pills and the last 7 pills are the inactive ones, and are usually a different color.
If you are using a 21–day pill pack, all the pills are active. When you are on continuous hormonal treatment for endometriosis, you will take an “active pill” every day in a continuous pattern.
What does “cyclic” use and “continuous” use mean?
Cyclic use means taking all the pills in the 28–day pack (21 active pills plus 7 inactive pills), then starting the next pack. This method results in periods and is not routinely used for the treatment of endometriosis. Some individuals may use pills cyclically but have a period less often; packages may have inactive pills every 3 months. This is sometimes called “extended cyclic use.”
Continuous use means taking active hormone pills every day without a break. If you are using the 28–day pill pack, you will take 1 active pill a day for 3 weeks (3 complete rows) and then start your next pill pack. You will not take the last row of inactive pills; throw them away. If you are prescribed the 21–day pill pack, finish the entire pack (3 rows) and then start your next pill pack the next day. Do not skip any days between pill packs. Most likely you will not have a period while you are taking the pill continuously, at the same time every day*, but some people may have breakthrough bleeding. Having up to four periods a year is considered normal on this method.
*Tip: If you decide to take the pill in the morning, make sure it is at a time you will be awake on weekdays and weekends. Set your cell phone alarm to remind you to take your pill at exactly the same time every day. If you are even 20 minutes late you may bleed or have pain.
What are the side effects of hormonal pills?
Most young peoplehave no side effects when taking hormonal pills, but some may experience side effects. Each type of hormonal pill can affect each persondifferently.
Spotting: Breakthrough bleeding between periods may occur while taking the first three weeks of hormone pills, but this is not serious. This usually happens during the first two or three cycles (2-3 months). You should call the GYN team if the bleeding is heavier than a light flow, or lasts more than a few days. It is very important that you take your hormone pills at exactly the same time* to keep your hormone levels in balance. This will lower the chance of having breakthrough bleeding.
Tip: If you decide to take the pill in the morning, make sure it is at a time you will be awake on weekdays and weekends. Set your cell phone alarm to remind you to take your pill at exactly the same time every day. If you are even 20 minutes late you may bleed or have pain.
Nausea: You may feel queasy or nauseous at times, but this may go away if you take the Pill with a meal or a snack. If the nausea doesn’t go away, your gynecologist may prescribe a pill with less estrogen; or another method that bypasses the GI system, such as the vaginal hormonal ring.
Headaches: Some people may get mild headaches when they start taking hormonal treatment. Although headaches usually happen because of stress or other reasons, be sure to let your GYN team know if the headaches are severe or if they continue.
Mood changes: Mood changes or mood swings can happen when taking hormonal treatment. Exercise and a healthy diet may help, but if they don’t, you may need to change the type of pill you are taking.
Acne: Usually hormonal treatment helps cure acne, but some peoplemay get acne from a particular pill.
Weight: Some peolegain weight, some lose weight, but most people stay exactly the same when they are taking the hormonal treatment. The pill is “zero calorie” and has not been shown to decrease your metabolism.
Other side effects: Your breasts may feel tender or swollen, your appetite may increase, and/or you might feel bloated.
Most often, side effects go away within the first 3 to 4 months of taking the hormonal pill. If the side effects are severe or if they don’t go away after three cycles, your gynecologist may switch you to a different hormonal pill or talk to you about other types of hormonal treatments for your endometriosis.
Are there serious side effects I should watch out for while taking the hormonal pill?
Most young people who take hormonal pills have few or no problems. However, if you have any of the following problems, go to the closest emergency room right away.
- Abdominal pain (severe)
- Chest pain (severe), cough, shortness of breath
- Headache (severe), dizziness, weakness, or numbness
- Eye problems (vision loss or blurring), speech problems
- Severe leg pain (calf or thigh)