Endometriosis for Parents: Continuous Hormonal Treatment (OCPs)

Single-Yellow-GirlCombination hormonal treatment is very effective for treating endometriosis. Hormonal treatment doesn’t “cure” endometriosis, but it may help with controlling your daughter’s pain by stopping her 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 daughter?

Not everyone should take hormonal pills. Your daughter will be asked questions about her medical history, such as whether she or anyone in your family has a history of blood clots. In addition, your daughter will not be given a prescription for estrogen pills if she has certain types of migraine headaches (with aura). There are different doses of hormones in different hormonal pills. Her gynecologist may prescribe a progestin–only pill if there is a medical reason why she should not take estrogen. Please tell your daughter’s gynecologist if your daughter 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 daughter is prescribed hormonal pills continuously (no inactive pills), then she probably won’t have a period. Hormonal pills will also lower her chance of getting endometrial (lining of the uterus) cancer and ovarian cancer, ovarian cysts, certain breast lumps, and may protect her from osteoporosis. Hormonal treatment may also improve acne, if she has it.

What is the difference between “active” and “inactive” hormonal pills?

Active pills contain hormone medicine. If your daughter’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 her pill pack. The inactive pills are in the last row of the 28–day pill pack and DO NOT contain hormone medicine. If her 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 she is using a 21–day pill pack, all the pills are active. If she is prescribed continuous hormonal treatment for endometriosis, she 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 daughter is prescribed the 28–day pill pack, she will take 1 active pill a day for 3 weeks (3 complete rows) and then start her next pill pack immediately. She will not take the last row of inactive pills; rather she will just throw them away. If she is prescribed the 21–day pill pack; when she finishes the entire pack (3 rows), she will start her next pill pack the next day. Your daughter should not skip any days between pill packs. Most likely she will not have a period while she is taking the Pill continuously, but some girls may have breakthrough bleeding. Having up to four periods a year is considered normal on this method. It is important to remind your daughter to take her hormone pills at the exact same time each day, not necessarily when she gets up or at bedtime since this may vary on a daily basis.

What are the side effects of hormonal pills?

Most women and teens have no side effects when taking hormonal pills, but some may. Each type of hormonal pill can affect each woman or 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. Your daughter 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 daughter takes her hormone pills at exactly the same time every day to keep her hormone levels in balance. This will lower the chance of having breakthrough bleeding.

Nausea: Your daughter may feel queasy or nauseous at times, but this may go away if she takes the Pill with a meal or a snack. If the nausea doesn’t go away, her 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 daughter’s GYN team know if her 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 she is 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.

Tip: Suggest that your daughter set her cell phone alarm as a reminder to take her pill at exactly the same time every day. If she is even 20 minutes late she may bleed or have pain.

Other side effects: Your daughter’s breasts may feel tender or swollen, her appetite may increase, and/or she 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, her gynecologist may switch her to a different hormonal pill or talk to her about other types of treatment.