Hormonal Therapies for Endometriosis: Exploring the Options

Some people cannot be cured, but everyone can heal.  — Unknown

Living with endometriosis is no easy feat. It’s a condition that not only comes with severe pain and discomfort but also affects your overall quality of life. While endometriosis currently has no cure, there are treatment options available to help manage its symptoms, one of the most common being hormonal therapies. These treatments aim to reduce the growth of endometriosis lesions and alleviate the debilitating pain that so many of us endure.

In this blog post, I’ll take you through five of the most common hormonal therapies used to treat endometriosis. I’ll share a little bit about how they work, why they might be prescribed, and the risks or side effects associated with each option. Please note that these are just some (not all) of the treatment options available, which I'm familiar with through personal experience, research, and discussions with my doctor. You can also conduct additional research beyond this blog post. It’s incredibly important to work with a qualified medical doctor or endometriosis specialist to develop a treatment plan tailored to your body.

1. Dienogest (Progestin Therapy)

Let me start with Dienogest, as it’s a treatment that’s personally worked for me. Dienogest is a type of progestin, a synthetic hormone similar to the natural hormone progesterone. It works by suppressing oestrogen production, which helps to slow down the growth of endometriosis lesions and prevent new ones from forming.

I’ve been on Dienogest for four and a half years now, and I’ve found that it has been life-changing in managing my endometriosis. One of the biggest issues I face is the recurrence of ovarian cysts, which this treatment has helped slow down significantly. On the rare occasions that I’ve gone off it—even for just a few days—I’ve experienced severe pain flare-ups, which have landed me in the emergency room. For me, it’s a crucial part of managing my symptoms and keeping the condition under control.

Why It’s Prescribed: Dienogest is often recommended for women who experience severe pain or frequent cyst formation. It’s particularly effective for reducing pain and slowing the progression of endometriosis.

Risks/Side Effects: While it has been a lifesaver for me, it does come with potential side effects, some of which I experience, including mood swings, weight gain, headaches, hair loss, insomnia and spotting or irregular bleeding. Not everyone tolerates it well, so it’s important to monitor your body’s response and work closely with your doctor.

2. Combined Oral Contraceptives (The Pill)

The birth control pill is one of the most common hormonal treatments for managing endometriosis. It works by suppressing ovulation and stabilising hormone levels, which helps reduce menstrual flow and lessen the growth of endometriosis tissue.

Why It’s Prescribed: The pill is often the first-line treatment for endometriosis, especially for women experiencing moderate symptoms. It’s convenient, widely available, and can also regulate periods and reduce period pain.

Risks/Side Effects: Some women experience nausea, breast tenderness, mood changes, or spotting while on the pill. Additionally, it may not provide sufficient relief for those with severe endometriosis, as was the case for me.

3. Gonadotropin-Releasing Hormone (GnRH) Agonists/Antagonists

GnRH medications, like Lupron or Orilissa, are designed to induce a temporary menopausal state by suppressing the production of oestrogen, the hormone that fuels endometriosis. These therapies are highly effective in reducing pain and slowing the progression of endometriosis but are typically used for short-term treatment due to their side effects.

Why It’s Prescribed: GnRH agonists/antagonists are usually recommended for severe cases of endometriosis, particularly when other hormonal treatments haven’t been effective.

Risks/Side Effects: Common side effects include hot flashes, vaginal dryness, mood changes, and loss of bone density (if used long-term). To mitigate the risks, doctors often prescribe "add-back therapy" to replace some of the hormones being suppressed.

Add-back therapy refers to a medical approach where small amounts of hormones (usually oestrogen and/or progestin) are given alongside certain treatments, such as GnRH agonists or antagonists, to help counteract the side effects caused by these medications. It's designed to alleviate these side effects by reintroducing just enough hormones to protect the bones and maintain overall well-being, without significantly interfering with the effectiveness of the treatment in suppressing endometriosis. The doses of hormones in add-back therapy are carefully calibrated. They’re not high enough to stimulate the endometriosis lesions but are sufficient to minimise side effects.

4. Progestin-Only Pills, Implants, or IUDs

Progestin-only options, such as the Mirena IUD or the mini-pill, work similarly to Dienogest by reducing oestrogen levels and preventing the growth of endometrial tissue. The IUD, in particular, provides localised hormone delivery directly to the uterus, which minimises systemic side effects.

Why It’s Prescribed: These options are ideal for women looking for long-term birth control that also helps manage endometriosis symptoms. The Mirena IUD, for example, can last up to five years and is often effective at reducing pain and heavy bleeding.

Risks/Side Effects: Side effects may include irregular bleeding, mood swings, or mild cramping during insertion. However, for many, the benefits outweigh the risks, making it a popular choice.

5. Danazol

Danazol is an older hormonal treatment that works by suppressing the production of certain hormones, essentially creating an environment where endometrial tissue cannot thrive. While it can be effective, it’s not as commonly prescribed today due to its side effects.

Why It’s Prescribed: Danazol is sometimes used when other treatments have failed to provide relief. It can help reduce pain and slow disease progression.

Risks/Side Effects: Danazol comes with significant side effects, including weight gain, acne, oily skin, deepening of the voice, and unwanted hair growth. These side effects can be a dealbreaker for many women, so it’s not usually a first-line treatment.

These are just some of the hormonal therapies available for managing endometriosis, but it’s important to remember that what works wonders for one person might not work at all—or could even cause adverse effects—for someone else. That’s why it’s so crucial to work with a qualified doctor or endometriosis specialist to find a treatment plan that’s right for your body and your lifestyle.

It’s important to note that some hormonal treatments for endometriosis can make it difficult—or nearly impossible—to fall pregnant while actively on them. This is due to side effects like stopping your monthly period (amenorrhea), suppressing ovulation, and reducing oestrogen production, which are essential components of the body’s natural fertility process.

These treatments are designed to manage endometriosis symptoms, but as a result, they often temporarily inhibit the ability to conceive. If you’re planning to start or expand your family, it’s crucial to consult your doctor or fertility specialist before stopping any treatment. Coming off hormonal therapy should be done under medical supervision to monitor how your body adjusts and to assess your chances of conception.

For some, pregnancy happens soon after stopping treatment, while others may find conception more challenging, depending on the severity of their endometriosis and other factors. In rare cases, pregnancy can even occur while on certain treatments. Regardless of the journey, having a healthcare provider by your side ensures you’re supported every step of the way, from managing endometriosis symptoms to working out the path to parenthood.

Endometriosis is an incredibly complex condition, and while hormonal therapies can help manage symptoms, they are not a cure. But with the right treatment plan and a supportive medical team, you can find ways to regain control and improve your quality of life. If you’re exploring treatment options, I encourage you to advocate for yourself, educate yourself about the available therapies, and, most importantly, listen to your body.

And let’s not forget: while these treatments can be effective, they’re only part of the puzzle. Lifestyle changes, self-care, and building a strong support system are equally important. You are not alone in this journey, and there is hope.

Disclaimer: This post is for informational purposes only and should not be used as a substitute for professional medical advice. Please consult with a healthcare provider before starting or changing any treatment plan.

Signed

#EndoWarriorH