Hormonal treatment is one of the main approaches used to manage endometriosis-related pain. It works by changing the hormonal environment that supports endometriosis tissue, particularly the effects of estrogen.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Depending on the medicine, treatment may reduce ovulation, lower estrogen activity, or directly suppress the activity of endometriotic tissue.
Hormonal treatment can reduce pain and other symptoms for many people, but it does not permanently remove endometriosis.
Symptoms may return after treatment is stopped, so the choice of therapy is usually based on symptom control, side effects, fertility plans, contraception needs, and individual preferences. You can also explore the Endometriosis Treatment guide for a broader overview of the condition and its management.
Why Does Hormonal Treatment Help Endometriosis?
Endometriosis is influenced by ovarian hormones, particularly estrogen. During the menstrual cycle, changes in hormone levels can stimulate endometriotic tissue, contributing to inflammation and pain. Hormonal treatments aim to interrupt this process in different ways.
Some reduce the hormonal fluctuations associated with ovulation and menstruation, while others create a stronger suppression of ovarian hormone activity.
As a result, hormonal treatment can:
- Reduce endometriosis-associated pelvic pain
- Make periods lighter or less frequent
- Reduce painful periods
- Suppress the activity of endometriotic tissue
- Reduce the likelihood of symptoms recurring while treatment is continued
The important distinction is that hormonal treatment generally controls the activity and symptoms of endometriosis rather than eliminating the underlying lesions.
What Are the Main Hormonal Treatments for Endometriosis?
The main hormonal options include combined hormonal contraceptives, progestogens, gonadotropin-releasing hormone (GnRH) agonists, and GnRH antagonists.
Aromatase inhibitors may be considered in selected situations, particularly when other treatments have not provided sufficient relief.
Combined Hormonal Contraceptives
Combined hormonal contraceptives contain estrogen and a progestogen. They can be used to reduce endometriosis-related pain and may also provide contraception.
They work partly by suppressing ovulation and reducing the normal hormonal fluctuations that occur during the menstrual cycle. They also reduce the hormonal stimulation of the endometrium and endometriotic tissue.
Depending on the specific product, they may be taken as:
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
- Combined oral contraceptive pills
- A vaginal ring
- A transdermal patch
Some people use combined hormonal contraception continuously rather than taking regular hormone-free intervals. This can reduce the number of menstrual periods and may help control menstrual pain.
Progestogen Treatment
Progestogens are medicines that act similarly to the body's natural hormone progesterone. They can suppress the activity of endometriotic tissue and are widely used for endometriosis-associated pain.
Progestogen treatment can be given in different forms, including tablets, injections, implants, or a levonorgestrel-releasing intrauterine system.
By reducing or altering the hormonal stimulation of endometriotic tissue, progestogens can decrease pain and may reduce menstrual bleeding.
One advantage of progestogen-only treatment is that it does not contain estrogen, making it an option for people for whom estrogen-containing contraception is unsuitable.
However, progestogens can cause side effects such as irregular bleeding, mood changes, headaches, breast tenderness, or other hormone-related symptoms. The type and intensity of side effects vary between medicines and individuals.
GnRH Agonists: A Stronger Form of Hormonal Suppression
Gonadotropin-releasing hormone (GnRH) agonists work higher up in the hormonal system. They initially stimulate GnRH receptors but, with continued treatment, suppress the signals that normally stimulate the ovaries. This results in a substantial reduction in estrogen production and creates a temporary low-estrogen state.
Because of this stronger hormonal suppression, GnRH agonists can be effective for endometriosis-related pain. However, they are generally considered when other hormonal treatments have not worked adequately, are not tolerated, or are unsuitable because of their side-effect profile.
Low estrogen levels can cause symptoms similar to menopause, including:
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
- Hot flushes
- Night sweats
- Vaginal dryness
- Reduced sexual comfort
- Mood changes
- Changes in bone mineral density with prolonged use
What Is Add-Back Therapy?
When GnRH agonists are used, a small amount of hormonal treatment may be given alongside them. This is known as add-back therapy.
The purpose is to reduce the unwanted effects of very low estrogen levels, particularly hot flushes and bone loss, while maintaining the treatment's effect on endometriosis-related pain. The exact add-back regimen depends on the medicine and the individual's circumstances.
GnRH Antagonists
GnRH antagonists also reduce ovarian hormone production, but they do so through a different mechanism from GnRH agonists. They block GnRH receptors directly, resulting in reduced stimulation of the ovaries and lower estrogen levels.
Because they suppress estrogen, GnRH antagonists can reduce endometriosis-associated pain. Depending on the specific medicine and dose, the degree of estrogen suppression can be adjusted.
Like GnRH agonists, GnRH antagonists can cause low-estrogen symptoms and may affect bone health. Some treatment regimens therefore include add-back therapy to reduce these effects.
Where Do Aromatase Inhibitors Fit In?
Aromatase inhibitors work by blocking the enzyme aromatase, which is involved in estrogen production. They can significantly reduce estrogen levels and may be considered for severe endometriosis-associated pain when other medical or surgical treatments have not provided sufficient relief.
They are generally not a first-line treatment because of their side-effect profile and the need to carefully manage their effects on bone health and ovarian hormone production.
Aromatase inhibitors are also generally used alongside other hormonal suppression in people who are still menstruating.
Does Hormonal Treatment Stop Endometriosis From Growing?
Hormonal treatment suppresses the hormonal activity associated with endometriosis and can reduce symptoms. It does not necessarily remove existing lesions.
Some hormonal treatments may reduce the activity of endometriotic implants while they are being used. However, stopping treatment can allow normal ovarian hormone activity to return, and symptoms may recur.
This is why hormonal treatment is usually viewed as a way of managing endometriosis over time rather than as a permanent cure.
Does Hormonal Treatment Cure Endometriosis?
No. Hormonal treatment is primarily used to control symptoms and suppress disease activity. It does not physically remove endometriosis lesions, adhesions, or ovarian endometriomas.
Surgery may be considered in selected situations when anatomical disease needs to be treated or when symptoms remain troublesome despite medical treatment.
Even after surgery, hormonal treatment may be considered for people who are not currently trying to become pregnant because it can help control symptoms and reduce the risk of recurrence.
Can You Take Hormonal Treatment If You Want to Become Pregnant?
Hormonal treatment for endometriosis is generally not used to improve fertility because these medicines work by suppressing ovulation or altering reproductive hormone activity. As a result, pregnancy is usually not possible while using most hormonal treatments.
However, current evidence does not indicate that hormonal treatment causes a permanent reduction in future fertility. Once appropriate treatment is stopped, fertility can be reassessed based on the individual's circumstances.
If pregnancy is your current goal, the treatment strategy may be different. Your healthcare professional may instead discuss expectant management, surgery in selected situations, or fertility treatment depending on factors such as age, ovarian reserve, tubal function, duration of infertility, and the extent of endometriosis.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
How Long Do You Need Hormonal Treatment?
There is no single duration that applies to everyone. Some people may use hormonal treatment for longer periods when it continues to control symptoms and remains medically appropriate.
The appropriate duration depends on the type of treatment, age, symptoms, side effects, reproductive plans, and other health considerations.
Treatment may be reviewed if symptoms return, side effects become troublesome, pregnancy becomes a priority, or the current approach no longer provides sufficient relief.
What Are the Common Side Effects?
Side effects vary depending on the hormonal treatment used. Some people experience few problems, while others may need to try a different medicine.
| Treatment | Possible Side Effects or Considerations |
|---|---|
| Combined hormonal contraceptives | Irregular bleeding, nausea, headaches, breast tenderness, and estrogen-related risks in people with certain health conditions |
| Progestogens | Irregular bleeding, mood changes, headaches, breast tenderness, or other hormone-related symptoms |
| GnRH agonists | Hot flushes, night sweats, vaginal dryness, mood changes, and reduced bone mineral density with prolonged use |
| GnRH antagonists | Low-estrogen symptoms and possible effects on bone health, depending on the regimen |
| Aromatase inhibitors | Hot flushes, vaginal symptoms, and effects on bone mineral density, requiring careful monitoring |
The presence of a possible side effect does not mean that it will occur. Treatment choices should take individual risks and benefits into account.
The Bottom Line
Hormonal treatment works by changing the hormonal environment that influences endometriosis, particularly by reducing or modifying estrogen activity. Combined hormonal contraceptives and progestogens are commonly used options, while GnRH agonists, GnRH antagonists, and, in selected cases, aromatase inhibitors provide stronger forms of hormonal suppression.
These treatments can significantly reduce endometriosis-related pain, but they do not permanently remove the disease. The most suitable option depends on your symptoms, health, fertility plans, contraception needs, previous treatment, and tolerance of side effects.
For many people, managing endometriosis is an ongoing process rather than a one-time treatment. Regular review allows the treatment approach to change when your symptoms, priorities, or reproductive plans change.
