Hormone Therapy for Endometriosis: 6 Treatments to Try
Gonadotropin-releasing hormone agonists, birth control pills and other hormonal contraceptives, and danazol can all be used to treat endometriosis.
“The goal of hormone therapy is to limit endometriosis growth,” explains Monte Swarup, MD, OB-GYN, founder of the leading vaginal health information site Vaginal Health Hub. Specifically, it works by keeping (or trying to keep) estrogen from stimulating endometrial growth.
Endometriosis is an idiopathic condition, which means it has no known cause.
There are a few different types of hormone therapy — each of which is outlined below. But broadly speaking, the goal of these therapies is to shrink endometriosis tissue.
Broadly speaking, GnRH agonists control the menstrual cycle. More specifically, they suppress ovulation.
If you’re a person who menstruates, your estrogen levels naturally rise and fall a few times throughout your monthly cycle. One of those times is during ovulation.
Estrogen fluctuations can cause the endometrial tissues that grow outside of your uterus to grow faster. The faster these tissues grow, the worse your symptoms may be.
By halting ovulation, these medications keep estrogen levels from rising, explains Swarup. “The ovulation suppression leads to significantly reduced estrogen exposure.”
It’s thought that this prevents endometrial tissues outside of the uterus from thickening and shedding outside of your usual period of menstruation.
GnRH agonists are typically prescribed after laparoscopic surgery — sometimes known as ablation or excision.
You may have a noticeable improvement in symptoms within 4 to 8 weeks of beginning treatment. Over time, you’ll experience fewer estrogen fluctuations and slower progression of the disease.
There are several different forms of GnRH agonists, each with its own timeline for use, including:
- a nasal spray used 2 to 4 times every day
- an injection every day
- an injection every 30 days
- an injection every 3 months
Consult with a clinician about selecting the best option for your lifestyle. All GnRH agonists are chemically similar, so each form is equally effective.
For some, endometriosis symptoms worsen after starting GnRH agonists. This typically lasts around 2 weeks.
Many people experience a menopause-like response, regardless of whether symptoms initially improve or worsen.
This may take the form of:
Of all the side effects, healthcare professionals are often most concerned with the potential for decreased bone density.
Your clinician may advise against this route of treatment if you have osteopenia, a condition marked by weaker bones, or have a family history of bone disease.
There are two types of oral contraceptives, also known as hormonal birth control pills. Both can be used to help with endometriosis.
Combination pills, which contain both estrogen and progestin, prevent ovulation and thin the uterine lining. “This can make periods less painful and lighter,” says Swarup.
Progestin-only pills function similarly.
According to Swarup, progestin-only pills are usually recommended for people who have heart disease or who are at risk of developing blood clots.
Birth control pills keep your estrogen levels from peaking at different points throughout your menstrual cycle, reducing endometriosis-related pain and discomfort.
Combination and progestin-only pills must be taken at roughly the same time each day to be effective.
Although you do need a prescription to receive birth control pills, you may be able to receive care via telehealth. Learn more about online birth control services.
The combination pill can cause:
The combination pill can also increase your risk of:
Side effects are rare with the progestin-only pill. If side effects do occur, they’re usually temporary and resolve within the first few months.
Potential side effects of the progestin-only pill include:
Oral contraceptives aren’t the only form of birth control used to treat endometriosis. Hormonal injections, implants, and intrauterine devices (IUDs) may also be used.
Birth control pills, implants, injections, and IUDs all offer the same benefits for folks with endometriosis — reduced pain and discomfort. How they offer these benefits varies from option to option.
Contraceptive injections such as Depo-Provera release progestogen into your bloodstream, which is thought to suppress estrogen release and therefore suppress endometrial growth. Roughly half of the people who use the shot stop menstruating entirely.
“This is an option if you can’t use estrogen-based contraception,” notes Swarup.
You must see a healthcare professional every 8 to 13 weeks to get another shot. If you fall off schedule, the shot won’t be as effective.
The contraceptive implant is inserted in the upper part of your arm by a doctor or other healthcare professional. It also releases the hormone progestogen directly into your bloodstream.
“It can be used for up to 3 years, making it a good option for those who don’t want to bother taking a daily pill,” says Swarup.
Hormonal IUDs are another ”set it and forget it” option. After the initial insertion at the doctor’s office, your IUD can be used for 3 to 5 years, depending on the type you choose.
“The IUDs with progestin secretion can help with endometriosis by keeping estrogen levels steady,” says Swarup. This includes Mirena, Kyleena, Skyla, and Liletta. “The copper IUD won’t help.”
As with other hormonal contraceptives, these side effects are often temporary and decrease within the first couple of months.
Some people experience the following after getting the shot or implant:
- pain or bruising around the injection or insertion site
- bleeding more or less than usual
- light bleeding or spotting between periods
- breast or chest soreness
- unexpected weight gain
In addition to the above side effects, the shot may cause feelings of depression. The implant may also cause benign ovarian cysts.
IUD insertion is often uncomfortable, and, for some people, quite painful. Other side effects include spotting or irregular periods.
“Danazol is an effective androgenic hormone used to treat endometriosis,” says Swarup. It functions much like testosterone and works to prevent the release of estrogen in the body.
When estrogen levels decrease, there’s usually a decrease in endometriosis-related growth and pains. “It can also shrink the uterus’ displaced tissue,” explains Swarup.
Many people will stop ovulating and menstruating within 2 months of starting the medication and will notice a relief in symptoms shortly after.
While it can be an effective short-term treatment, most people don’t take it for longer than 6 to 9 months. It’s common for people to experience regrowth following treatment.
It isn’t frequently prescribed due to its extensive risk of side effects, says Swarup.
This more commonly includes:
If you suspect that you have endometriosis, or have an endometriosis diagnosis and are curious about potential treatment options, talk with a healthcare professional.
“The right provider will help you understand the different treatment options, and work with you to find the option(s) best for you,” says Swarup.
Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.