What is Endometriosis?
Endometriosis is a benign gynaecological condition that is estimated to affect 10% of women in the general population and appears to be increasing in incidence. It is an estrogen-dependent inflammatory disease and is primarily characterized by menstrual pain, pain during sexual intercourse, chronic pelvic pain, and variable effects on fertility. The symptoms may greatly affect the quality of life, and symptoms control may be the primary aim of initial management, while the contraceptive effect is often secondary.
Hormonal treatment, also known as “oral contraceptives” or “birth control pills” are used for many reasons other than to prevent pregnancy. Combination hormonal treatment is very effective for treating endometriosis. Hormonal treatment doesn’t “cure” endometriosis, but it may help with controlling pain by stopping your periods and preventing endometriosis from getting worse.
What exactly are hormonal pills?
Hormonal pills contain the hormones estrogen and progestin, which are similar to the hormones that are normally made by the ovaries. There is also another type of pill that contains only one hormone (progesterone), and is called either the “progestin–only pill”, or the “mini–pill”. Progestin is a synthetic hormone that functions like progesterone. While there are no absolute findings yet, some women with endometriosis appear to do better on high progestogenic pills. High doses of progesterone can limit or stop menstrual bleeding altogether.
Many women with period pain, especially adolescents, who could have endometriosis but don’t have a (laparoscopy-confirmed) diagnosis are prescribed the pill to reduce their pain. The hormones in the pill causes the uterus lining to become thinner, causing periods to become shorter and lighter, thus reducing endometriosis symptoms. These women may only be diagnosed with the disease once they stop taking the pill and their symptoms return or increase.
Depending on your symptoms, some studies suggest that the pill be taken daily consecutively for 3 Weeks, followed by a break of 1 week, during which time you will have a light period. This is the way the pill is taken when used as a contraceptive.
However, with endometriosis-associated pain, it is recommended that the pill be taken daily continuously; or daily for blocks of 3–4 months, followed by a break of 1 week, during which time you will have a light period.
Taken in any of these ways, you can safely use the pill for many years.
Theoretically, taking the pill continuously for 3–4 months should be more effective in suppressing endometriosis than taking it for blocks of 3 weeks, because it results in fewer menstrual periods. However, little research has been done to support this hunch. In one study involving women whose symptoms had not been alleviated with cyclic (3 week blocks) use of the oral contraceptive pill, 80% of the women were satisfied or very satisfied with the results of taking the pill continuously.
Most women have no side effects when taking hormonal pills, but some may experience mild side effects.
Each type of hormonal pill can affect each woman or teen differently. Side effects that you may experience are :
Spotting: Breakthrough bleeding between periods may occur while taking the first three weeks of hormone pills, but this is not serious. This usually happens during the first two or three cycles. You should call your doctor if the bleeding is heavier than a light flow, or lasts more than a few days. It is very important that you take your hormone pills at exactly the same time to keep your hormone levels in balance. This will lower the chance of having breakthrough bleeding.
Nausea: You may feel queasy or nauseous at times, but this may go away if you take the Pill with a meal or a snack. If the nausea doesn’t go away, your doctor may prescribe a pill with less estrogen.
Headaches: Some women may get mild headaches when they start taking hormonal treatment. Although headaches usually happen because of stress or other reasons, be sure to let your doctor know if the headaches are severe or if they continue.
Mood changes: Mood changes or mood swings can happen when taking hormonal treatment. Exercise and a healthy diet may help, but if they don’t, you may need to change the type of pill you are taking.
Acne: Usually hormonal treatment helps cure acne, but some women may get acne from a particular pill. Acne Treatment
Weight: Some women may gain weight, some lose weight, but most stay exactly the same when they are taking the hormonal treatment.
Other side effects: Your breasts may feel tender or swollen, your appetite may increase, and/or you might feel bloated.
Most often, side effects go away within the first 3 to 4 months of taking the hormonal pill. If the side effects are severe or if they don’t go away after three cycles, your doctor may switch you to a different hormonal pill or talk to you about other types of hormonal treatments for your endometriosis.
While early diagnosis is ideal, endometriosis is thought to be less likely to progress while women are taking the pill, making a delayed diagnosis less worrying. But when it comes to managing endometriosis, not all contraceptives are equal. And what works for one woman many not be the best choice for another.
It is estimated that 30%–50% of women with endometriosis have an infertility problem, so a considerable number of endometriosis sufferers will require effective, planned contraception to maximize “protection of fertility” and prevent progression of the endometriotic condition. Ideally, the oral contraceptives should also provide symptom relief and improvement of physical, mental, and social well-being.
If you want to learn more about endometriosis please speak to our doctors today!