Some doctors may prescribe birth control pills (also known as combined oral contraceptives) to treat endometriosis symptoms such as pelvic pain. However, they come with several side effects and the risk of symptom flare-ups.
What are birth control pills?
Birth control pills are pills that contain progestin (the synthetic version of the female hormone progesterone) and estrogen. A birth control pill may contain both hormones or only progestin. The ones that contain both hormones are called combined oral contraceptives (COCs) or combination birth control pills. Progestin-only pills (POPs) that are low-dose are also called the minipill.
How do they work?
Birth control pills work by preventing ovulation, thereby preventing pregnancy. They can also thicken the cervical mucus to prevent the entry of sperm inside the uterus or thin the endometrium or lining of the uterus to prevent the attachment of a fertilized egg.
How is a minipill different from a COC?
The progestin dose in a minipill is lower than what is available in a COC. Doctors prescribe a minipill or other higher dose POPs in cases where taking estrogen is risky such as during breastfeeding or if a woman has a history of blood clots for example.
Why do doctors prescribe birth control pills for endometriosis?
The endometrial-like tissue that grows outside the uterus in case of endometriosis also responds to female hormones like the normal endometrium. This leads to heavy periods, menstrual clots, and dysmenorrhea. Stopping periods from occurring with the help of birth control pills can help relieve some of these symptoms temporarily.
Though there is no clinical evidence of the efficacy of birth control pills for endometriosis, superficial improvements in symptoms such as dysmenorrhea and the fact that COCs are generally well-tolerated by most women have prompted healthcare providers to offer them as the first line of treatment.
Are they really effective for endometriosis?
Birth control pills, especially the COCs, are not really an effective treatment option for endometriosis. Though the pills may reduce bleeding, they do not always reduce pain. Besides, the use of COCs can cause side effects such as spotting, breast tenderness, headaches, nausea, increased blood pressure, bloating, and weight gain.
Serious side effects include blood clots in the legs, and liver and gall bladder disorders. There is also an increased risk of heart attack and stroke in smoking women above age 35.
Can birth control pills worsen symptoms?
Yes. Endometriosis is an estrogen-dependent disease. Recent research suggests that the use of combined oral contraceptives can worsen endometriosis symptoms due to estrogen dominance. There also seems to be an increased risk of endometriosis in women who have previously used COCs compared to those who are new to the therapy.
Which birth control pills are better?
The minipill is a better alternative to COCs to manage the symptoms of endometriosis. Continuous administration of progestin thins the lining of the uterus, which not only stops normal periods but also acts against the endometriosis lesions themselves. Chances of spotting are also lower.
Are there any side effects of using progestin-only pills?
Though progestin-only pills (including minipills) are a better alternative to COCs to treat endometriosis, they have some limitations as well. POPs may not be suitable if a woman has a history of breast cancer, liver disease, or uterine bleeding that has not been worked up. POPs also carry the risk of causing irregular menstruation, acne, breast tenderness, nausea, reduced libido, headaches, and ovarian cysts.
What is the best alternative?
Endometriosis lesions can occur not only in the uterus but in several areas of the pelvic cavity and even outside. Only complete removal of these lesions can result in total alleviation of symptoms and the only way of accomplishing this is by laparoscopic deep excision surgery.
The surgeons at Seckin Endometriosis Center are skilled in locating even hard-to-reach lesions using a patented Aqua Blue Contrast technique and removing them using cold excision. This minimizes damage to surrounding healthy tissue and helps preserve fertility.