Endometriosis is a condition characterized by the abnormal growth of endometrial-like tissue outside the uterus.
Like the endometrium (the lining of the uterus), these growths or lesions thicken and break down with each menstrual cycle. But because they have no safe route to exit the body, they cause local inflammation and pain.
Hormonal therapies can help relieve the symptoms of endometriosis by lowering the levels of estrogen, a hormone known to promote the growth of endometrial lesions. Because hormonal therapies interfere with the menstrual cycle, they reduce menstruation-associated pain.
There are different kinds of hormonal treatments; among them are hormonal contraceptives. Hormonal contraceptives are usually well-tolerated and can safely be taken for many years, which is not the case for most other hormonal treatments.
How hormonal contraceptives work
Hormonal contraceptives contain either synthetic versions of progesterone and estrogen, or progesterone only.
Progesterone plays an essential role in the menstrual cycle as it prepares the uterus for the implantation of a fertilized egg. Estrogen is required for the thickening of the endometrium and has similar effects on endometrial lesions outside the uterus. Progesterone counteracts the activity of estrogen; when progesterone levels are high, estrogen levels are low and vice versa. Contraceptives containing progesterone-like hormones thereby reduce the growth of endometrial lesions. Progestogen-only contraceptives are usually preferred for endometriosis.
Types of hormonal contraceptives
Progestogen-releasing intrauterine systems
Mirena is a device that is placed inside the uterus. It releases the progesterone-like hormone levonorgestrel. Menstrual periods become shorter and lighter over time and may stop. As a consequence, menstruation-associated pain is reduced. The device can be left inside the uterus for up to five years, after which it must be removed or replaced.
Subdermal progestin implants
Subdermal progestin implants are small plastic rods placed under the skin of the inner upper arm. They are effective for three years. Nexplanon is one such implant that contains the progesterone-like hormone etonogestrel.
Depot medroxyprogesterone acetate
Depo-SubQ-Provera 104 contains the progestin medroxyprogesterone. The hormone is injected under the skin every 12 to 14 weeks. Clinical trials have shown that Depo-SubQ-Provera 104 can reduce endometriosis-associated pain.
Depo-Provera is similar to Depo-SubQ-Provera 104 but contains a lower dose of medroxyprogesterone.
Oral progestogen-only contraceptives
Oral progestogen-containing contraceptives are taken once daily without interruption. They can alleviate endometriosis-associated pain and reduce endometrial lesions.
Oral estrogen/progestogen contraceptives
Combination contraceptives contain estrogen and progestogen. They can reduce the size of endometrial lesions and alleviate endometriosis-associated pain.
Seasonique (ethinyl estradiol and levonorgestrel) is commonly used in endometriosis. The package contains two different kinds of tablets. Tablets that contain levonorgestrel and ethinyl estradiol are taken daily for 84 consecutive days and tablets that contain only ethinyl estradiol are taken the following seven days.
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