An endometriosis diagnosis: Hormone treatments may help

July 7, 2021

Providence Women's Health Team

[5 MIN READ]

Millions of women in the US have endometriosis, a painful inflammatory condition where cells that usually line the inside of the uterus grow on the outside.
Dr. Brooke Winner explains hormone suppression treatments options that reduce pain.
Though there is no cure, Providence doctors offer solutions for women to treat endometriosis at every stage.

Padma Lakshmi, author, actress, host and executive producer of the TV show “Top Chef,” describes the impact endometriosis had on her life from the time she got her first period at 13:

“Growing up, I watched my mother struggle with period pain, and I assumed that was normal. So, when I started experiencing severe cramps and excessive bleeding, no one batted an eyelash. As I got older, my symptoms continuously worsened. Bedridden every month because of my period, I missed out on family time, social engagements and professional opportunities.”

Lakshmi’s story is shared by millions of women around the country. Researchers believe more than six million women in the United States have endometriosis. It’s a painful inflammatory condition in which cells like those that line the uterus are growing outside the uterus.

Unfortunately, there’s no cure for endometriosis currently. But there are treatments to help deal with symptoms and the problems caused by the condition. Hormone suppression therapy is one that may offer relief.

How is endometriosis diagnosed?

Dr. Brooke Winner, a fellowship-trained, minimally invasive gynecologic surgeon and the medical director for Gynecologic Surgery at Swedish Medical Center says, “An ultrasound will show an endometrioma, which is an ovarian cyst filled with endometriosis, but smaller spots won't show up.”

Dr. Winner explains, “The only way to know for sure if someone has endometriosis is to do laparoscopic surgery and look in with a camera. If we see something that looks like endometriosis, we’ll take out the tissue and send it to the lab. This is the gold standard for diagnosing endometriosis.”

Types of hormone treatments for endometriosis

There are several things healthcare providers consider when deciding on the best way to treat endometriosis symptoms. They usually look at:

Age
How acute your symptoms are
How severe the disease is
Whether you plan to have children

One of the primary treatments for women with endometriosis is hormone suppression. “If the ultrasound is normal,” explains Dr. Winner, “there’s a good chance it would be effective to take birth control pills to skip your periods or use an IUD containing hormones to suppress periods. These hormones could help ease pain and stop endometriosis from growing.”

Hormone suppression to treat endometriosis

Hormones cause patches of endometriosis tissue to follow a cycle that’s similar to the menstrual cycle. In turn, this means hormones can also work to treat endometriosis symptoms. Not only that, but different hormones may also change the way a woman experiences pain.

Hormone treatments stop (or suppress) the ovaries from producing hormones, including estrogen. Hormones also usually prevent ovulation, which may help slow the growth and local activity of both the endometrium and the endometrial lesions. This can help lessen the pain from the condition.

Be sure to discuss possible side effects with your doctor before and during treatments.

Common hormone suppression therapies include:

Birth control pills

As a treatment, oral contraceptives help make a woman’s period shorter, lighter and more regular. Birth control pills may also provide relief from the pain of endometriosis.

“Choosing the right birth control pill is important,” says Dr. Winner. “Most pills contain both female hormones: estrogen and progestin. All pills contain the same type of estrogen, but the dose can vary. Different pills contain different types of progestin. Adjusting the amount of estrogen and type of progestin can help control bleeding and minimize side effects.”

Pain relief usually lasts only while the endometriosis is suppressed by taking the pills. When treatment stops, endometriosis symptoms may return. Many women use this type of hormone treatment indefinitely. And even after stopping it, some women have no pain for several years.

Gonadotropin-releasing hormone (GnRH) treatments

These hormones stop certain hormones from being produced. They prevent ovulation and menstruation and keep endometriosis from growing. In essence, this treatment sends the body into a “menopausal” state.

Most doctors recommend staying on GnRH medicine for only about six months at a time. Treatments may be repeated every few months, and just like with birth control pills (and all hormonal treatments), endometriosis symptoms return after women stop taking GnRH medicines .

Progesterone and progestin

These hormones can be taken by injection, as a pill or through an intrauterine device (IUD) containing progestin. These hormones improve symptoms by reducing or stopping a woman’s period.

An IUD containing progestin may help reduce pain associated with endometriosis. It makes lesions smaller and cuts down on the menstrual flow. When an injection of these hormones is taken every three months, they usually stop menstrual flow. However, some women may still have irregular menstrual bleeding in the first year, and during times when they’re bleeding, women may have pain.

When surgery is needed to treat endometriosis

According to Dr. Winner, “Hormonal treatments won’t work if there’s an endometrioma, which is that inflamed endometrial tissue in and sometimes on the ovary. If a patient tries birth control pills or an IUD for three to six months with no pain relief, or they have side effects they can’t tolerate, the next step is laparoscopic surgery. Also, if someone is actively trying to get pregnant, then birth control is counterproductive. Going straight to laparoscopy would be reasonable.”

Dr. Winner explains that, after surgery to remove the endometriosis, some women choose to go on birth control to suppress their periods, which can help with pain. She says, “The treatment options are similar to before surgery, usually either birth control pills or an IUD. In women who have had an endometrioma surgically removed, we know for sure that taking pills on an ongoing basis to skip periods greatly lowers the risk of endometrioma coming back.”

Working to find a cure for endometriosis

Padma Lakshmi considers herself lucky because she found proper treatment, was able to have a child and enjoy relief from pain. But she also knows that many women of reproductive age have endometriosis, one of the leading causes of hysterectomy and female infertility. That’s what inspired her to act and co-found the Endometriosis Foundation of America, an organization that works to improve the lives of those affected by this condition.

Most importantly, Lakshmi is optimistic that “We have the technology and brainpower to find a cure.”

Find a doctor

If you want to learn more about lowering your endometriosis risk or treating the condition,you can find a Providence doctor using our provider directory.