I was diagnosed with endometriosis 6 years ago and my symptoms improved by taking Beyaz birth control.  My doctor unexpectedly closed her office last month and I have been unable to refill my prescription.  I’ve been off the birth control pills for 3 weeks and I’m experiencing difficult side effects including dizziness, headaches, cramping, and fatigue.  I am not happy with how extremely my body is reacting to the hormonal change.  I would like to try different ways to treat the symptoms of my endometriosis.  I would LOVE to hear more about my options to manage my current symptoms and long-term pain management.

(photo credit: Growley-Ferret via Flickr)

Up to 10% of reproductive-age women have endometriosis, a condition where the endometrial tissue typically found in the uterus exists outside the uterus.  Endometriosis can have a range of symptoms and you’re clearly experiencing some intolerable ones.  Women may experience pain in many forms…just before and during their periods, with bowel movements, with urination, with sex, or general pelvic or back pain.  As many as 1 in 5 women who have endometriosis will experience infertility.  Since you are not trying to conceive at this time, the treatment will be focused on reducing your pain and other related symptoms.

Using A Pain Reliever

To alleviate some of the pain, over-the-counter anti-inflammatory medicines, such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can be taken.  This helps reduce the inflammation that may be contributing to the pain.  These medicines should be used and not acetaminophen (Tylenol) because that works in a different and in this case, less effective, way.  Talk to your health care provider about appropriate dosing since you may need more than what is typically recommended for these over-the-counter medicines.

Manipulating Hormones

To really get at the root of the problem and regulate the hormones, we have to manipulate the hormones by taking hormones.

Birth Control Pill

The first step is to try a hormonal birth control such as a birth control pill with a combination of estrogen and progestin hormones.  When taking a combination birth control pill, eventually the endometrial tissue stops building up.  Talk to your health care provider about which formulation would be best for you.  Typically, a formulation that is progestin dominant and contains a more androgenic progestin will be most effective.  The pills should be taken continuously, and the inactive placebo pills skipped, to get the maximum benefit of reducing pain.

Beyaz is similar to Yaz, a popular birth control pill, with added folic acid (to prevent neural tube defects in case of pregnancy).  While this formulation is progestin-dominant, it is not an androgenic-progestin.  An alternative to try would be to try Loestrin 1/20 or Microgestin 1/20.

Birth Control Shot

Another form of birth control that can help relieve symptoms of endometriosis is the injectable shot, known as DepoProvera (depot medroxyprogesterone acetate).  This shot is given only once every 3 months.

Birth Control IUD

The Mirena intrauterine device releases a progestin hormone to alleviate the painful symptoms of endometriosis similarly to the birth control shot.  The hormone is released locally in the uterus and therefore has fewer side effects such as weight gain and bone loss.  This is also a highly effective form of birth control that, once inserted, works to prevent pregnancy for five years.

Oral Progestin Hormones

If you are not interested in preventing pregnancy while treating endometriosis or this treatment doesn’t give you enough relief, there are other options.  Pills with higher doses of progestin hormone can be used and work similarly to prevent buildup of endometrial tissue.  Side effects may include weight gain and breakthrough bleeding.

Gonadotropin-Releasing Hormone Agonists

These medicines last much longer than the other hormones.  This is a good option for women who did not respond to birth control pills.  These medicines, known as nafarelin nasal spray (Synarel), leuprolide shot (Lupron Depot), and goserelin shot (Zoladex), work by reducing estrogen levels in the body, creating a state similar to menopause.  This medicine has some uncomfortable side effects (see previous post).  Combination estrogen and progestin hormones or progestin alone can be added on to manage these side effects.

Danazol

This is a derivative of the hormone testosterone and was the first treatment actually approved for endometriosis.  It works by counteracting estrogen and comes along with the effects of testosterone, such as unwanted hair growth, mood changes, acne, and deepening of the voice.

Surgery

Surgery is the closest thing to a permanent fix to this problem.  Although one surgery may not be enough and we always have to weigh the risks of surgery with the benefits.

Problematic tissue can be treated by laparoscopically visualizing the lesion and either removing it or ablating it with a laser.  For more severe endometriosis, there are other procedures to interrupt nerve fibers.

Women who are not planning to become pregnant can consider a hysterectomy to remove their uterus, potentially along with the ovaries.  This basically puts a woman in menopause, so there are other symptoms to manage there.

Natural Options

There are some natural options that may help cope with a minimal or mild form of this condition.  See the list in a recent post on this subject.

I hope this information is helpful and guides the discussion with your healthcare provider.

Got a question? Send it to us.

— Dr. Sally Rafie

This is for informational purposes only and is not a substitute for medical advice, diagnosis or treatment, and is not meant to replace a one-on-one relationship with a healthcare provider.