Birth Control Pills for Managing Endometriosis: Which Ones to Choose?

According to the World Health Organization, approximately 190 million women and girls worldwide are affected by endometriosis. It can improve on its own at times, but it can deteriorate if not treated. Although there is no permanent cure for this condition, there are several ways to manage the symptoms and ensure minimal disruption to daily life. The choice of treatment is determined by criteria such as the patient’s age, symptoms, and pregnancy plans. Doctors can recommend hormone therapy, pain relieving medications, hormonal contraceptives, and even surgery in a few cases, to help alleviate the symptoms.

If a patient is not attempting to conceive, their doctor may advise them to use hormonal birth control pills to treat their endometriosis symptoms. Hormonal contraceptives can not only make periods shorter, lighter, and more regular; they can also help relieve pain and discomfort and hinder the growth of endometrial tissue affected.

Yet, even within the realm of birth control pills, variations exist, with certain options proving more compatible for specific individuals while others may not be as suitable. This prompts the question: Which variant should one opt for?

Which birth control pills are most used for endometriosis treatment? How do they help in managing the symptoms?

Birth control pills come in two varieties: combination pills and progestin-only pills.

Combined Pill

This pill comprises the two main female sex hormones, estrogen and progestin. These can be found in the combinations of levonorgestrel and ethinyl estradiol or drospirenone and ethinyl estradiol.

This combination inhibits ovulation, or the release of eggs from the ovaries, as well as reducing the growth of endometrial tissue, and thinning the uterine lining. Doctors will advise a person to take this pill once every day for 21 days, followed by a 7-day respite which is usually during a bleeding period.

Progestin-only Pill

Progestin is a synthetically produced hormone that is comparable to progesterone, the sex hormone released naturally in the female body. It works by weakening the uterine lining and preventing ovulation and regular menstruation. It also inhibits the growth of endometrial-like tissue and alters the mucus that coats the uterus. Progestin-only pills are also known as “mini-pills” can be sold under the generic types of norethindrone or drospirenone.

For this pill to be successful, it must be taken at the same time every day, without taking a 7-day break.

What are the most common side effects of using birth control pills to treat endometriosis?

Though a combined estrogen and progestin therapy is generally considered safe and is well-tolerated by most women, it's important to be aware of potential side effects. Some individuals might experience nausea or slight weight gain initially. While the risk is small, there is also an increased chance of blood clots in the legs or lungs due to the presence of estrogen. Therefore, this option is not recommended to patients suffering from heart diseases and those prone to strokes.

The progestin-only pill, though better for patients with heart problems, may also entail certain side effects. These can encompass weight gain, mood fluctuations, acne, heightened hair growth, bloating, cramps, breast tenderness, and irregular bleeding or spotting during periods.

It's worth noting that symptoms of endometriosis might return once either treatment is discontinued. Neither of the pills are recommended to patients who are already gestating.

What are some alternative treatment options for endometriosis, and how do they compare to birth control pills? 

For more severe cases, wherein symptoms cannot be controlled by hormonal birth control tablets or by anti-inflammatory medicines/painkillers (like ibuprofen or paracetamol), the healthcare provider may propose more invasive or surgical treatments, such as one of the following:

Gonadotropin-releasing hormone (GnRH) Analogues

GnRH Analogues are temporary medications that induce a state similar to menopause. While on these medications, menstrual periods stop, effectively reducing pain associated with endometriosis and halting the growth of endometrial tissue in most instances. However, they come with potential side effects like hot flushes, night sweats, vaginal dryness, and mood changes. It is important to note that extended use may lead to bone thinning. Like other treatments, there's a possibility of symptom recurrence upon discontinuation. Notably, GnRH Analogues are not contraceptive measures, and caution should be exercised to prevent pregnancy while on this medication. Additionally, the cost for continuous doses can be a consideration when opting for this treatment route.

Laparoscopy

Laparoscopy is a diagnostic and potentially long-lasting mitigating procedure for endometriosis. This surgical approach can also bring relief to individuals who cannot undergo medical treatments. It's important to note, however, that not all forms of endometriosis can be effectively addressed through laparoscopy. While the procedure holds promise, it is not without risks, including pain, bleeding, infection, and potential damage to organs such as the bladder, bowel, ureter, or ovary. Additional concerns involve scarring, blood clots, and the possibility of requiring a larger abdominal incision.

Hysterectomy

Removal of the entire uterus can be a compelling option, as it grants a lasting respite to more than 90 percent of women dealing with endometriosis. This surgical approach not only reduces or eliminates the necessity for prolonged medication usage, but also results in the termination of menstrual cycles. It is important, however, to acknowledge that this route entails higher surgical risks compared to laparoscopy. Moreover, the patient’s fertility is also irreversibly compromised. The removal of ovaries might also call for additional hormone replacement therapy to manage hormonal imbalances. It is important to note that although hysterectomy and endometriosis removal can bring relief, they may not invariably eradicate pain.

Key Takeaways

In a nutshell, endometriosis can be effectively managed through a spectrum of treatment options, with birth control pills emerging as a potential path to relief. These pills, available in combined and progestin-only forms, strive to improve symptoms by regulating hormonal imbalances and restraining endometrial tissue growth. While potential side effects exist, understanding these nuances can empower informed decision-making for patients. However, it is important to acknowledge that discontinuing treatment might make symptoms resurface. Alternative treatments like GnRH Analogues, laparoscopy, and hysterectomy can also be explored. Once again, consulting a healthcare provider is paramount to ensure a tailored approach, effective symptom management and an enhanced quality of life.