Hormonal contraceptives are widely used for contraception and generally accepted. They contain low doses of hormones (estrogen and progesterone) and can reduce pain associated with endometriosis by stopping follicular growth and hence reducing the production and concentration of estrogens. Low estrogens stop the activity of the growth of the endometrium in and outside the uterus, and thus pause endometriosis. The progesterone in the pill decreases the activity of the endometrium directly.

The side effects are limited and hormonal contraceptives are not expensive. Your doctor can prescribe different types of hormonal contraceptives:

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    The oral contraceptive pill (taken with or without a monthly pill-free week)
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    A vaginal contraceptive ring
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    A transdermal patch

Women with endometriosis are often advised to take hormonal birth control continuously (back to back packs) for three or more months. This concept is to reduce the amount of withdrawal bleeds and pain, however some women experience breakthrough spotting and bleeding.

Discuss this option and the side effects with your doctor. Your GP and Gynaecologist can prescribe this type of treatment in Ireland.

What are the side effects of hormonal treatment?

Since the aim of treatment in endometriosis-associated pain is lowering the level of estrogens, the side effects are related to a low estrogen level. Besides that, the side effects are related to the drugs used to reach that low estrogen level.

Side effects are therefore related either to low estrogens (hormonal contraception, GnRH analogues) or to progesterone (hormonal contraception, progestagens).

Some examples of side effects of hormonal treatment for pain in endometriosis are headaches, acne, weight gain, vaginal spotting, fatigue and hot flushes.

These side effects differ strongly between treatments and between patients. As a result, a certain treatment can be a good option for one woman, but the same treatment can have severe side effects in another woman. Your doctor should discuss side effects with you when prescribing hormonal treatment.

Medical treatment before or after surgery

There is some controversy on this subject. The guideline group does not recommend hormonal treatment before surgery to improve the results of the surgery. Of course, many women in pain get hormonal treatment during a waiting period before surgery. After surgery, starting with an oral contraceptive pill or using a levonorgestrel-intrauterine device may prevent recurrence of pain.

Is surgical treatment an option for relieving pain symptoms?

Surgical treatment of endometriosis focuses on the elimination of peritoneal endometriosis/endometrioma/deep endometriosis and division of adhesions.

In the past, open surgery or laparotomy was used routinely. Nowadays, laparoscopy is used frequently and preferred since it usually results in less pain, shorter hospital stay, quicker recovery and a smaller scar. However, laparotomy and laparoscopy are equally effective in treating pain symptoms in women with endometriosis.

Therefore, clinicians should consider surgical treatment (elimination of endometriotic lesions) when they see endometriotic lesions during laparoscopy for diagnosis.

If deep endometriosis is suspected, doctors are recommended to refer their patient to a centre of expertise, as these surgeries may be difficult.

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