Combination hormonal treatment is very effective for treating endometriosis. Hormonal treatment doesn’t “cure” endometriosis, but it may help with controlling your child’s pain by stopping their 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 preventing 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 progesterone hormone medicine in them), and progestin–only pills that contain just progesterone. 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 contains all active hormone pills and the 28–day pack which contains 3 weeks of active hormone pills and 1 week of inactive (placebo) pills.
How do I know if hormonal pills are right for my child?
Not everyone should take hormonal pills. Your child will be asked questions about their medical history, such as whether they or anyone in your family has a history of blood clots. In addition, your child will not be given a prescription for estrogen pills if they have certain types of migraine headaches (with aura). There are different doses of hormones in different hormonal pills. Their gynecologist may prescribe a progestin–only pill if there is a medical reason why they should not take estrogen. Please tell your child’s gynecologist if your child suffers from migraine headaches or if anyone in your family has been treated for blood clots or stroke.
Are there other medical benefits to taking hormonal pills?
Yes. If your child is prescribed hormonal pills continuously (no inactive pills), then they probably won’t have a period. Hormonal pills may lower their chance of getting endometrial (lining of the uterus) cancer and ovarian cancer, ovarian cysts, certain breast lumps, and may protect them from osteoporosis. Hormonal treatment may also improve acne, if they have it.
What is the difference between “active” and “inactive” hormonal pills?
Active pills contain hormone medicine. If your child’s 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 their pill pack. The inactive pills are in the last row of the 28–day pill pack and DO NOT contain hormone medicine. If their 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 they are using a 21–day pill pack, all the pills are active. If they are prescribed continuous hormonal treatment for endometriosis, they 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.
Continuous use means taking active hormone pills every day without a break. If your child is prescribed the 28–day pill pack, they will take 1 active pill a day for 3 weeks (3 complete rows) and then start their next pill pack immediately. They will not take the last row of inactive pills; rather they will just throw them away. If they are prescribed the 21–day pill pack; when they finishes the entire pack (3 rows), they will start their next pill pack the next day. Your child should not skip any days between pill packs. Most likely they will not have a period while they are taking the Pill continuously, but some teens may have breakthrough bleeding. Having up to four periods a year is considered normal on this method. It is important to remind your child to take their hormone pills at the exact same time each day, not necessarily when they get up or at bedtime since this may vary on a daily basis.
What are the side effects of hormonal pills?
Most teens have no side effects when taking hormonal pills, but some may. Each type of hormonal pill can affect each teen differently.
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). Your child 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 your child takes them hormone pills at exactly the same time* every day to keep their hormone levels in balance. This will lower the chance of having breakthrough bleeding.
Nausea: Your child may feel queasy or nauseous at times, but this may go away if they take the Pill with a meal or a snack. If the nausea doesn’t go away, their gynecologist may prescribe a pill with less estrogen.
Headaches: Some teens 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 child’s GYN team know if their 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, the type of pill they are taking may need to be changed.
Acne: Usually hormonal treatment helps to improve acne, but some teens may get acne from a particular hormonal pill.
Weight: Some teens gain weight, some lose weight, but most teens stay exactly the same when they are taking hormonal treatment.
Other side effects: Your child’s breasts may feel tender or swollen, their appetite may increase, and/or they may 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, their gynecologist may switch them to a different hormonal pill or talk to them about other types of treatment.
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