From the Guidelines
Hormonal birth control methods, particularly combined hormonal contraceptives and progestin-only options, are the most effective choices for managing endometriosis-related pelvic pain. According to the American College of Obstetricians and Gynecologists (ACOG) 1, these methods can help reduce or eliminate menstrual periods, which often decreases endometriosis pain.
Key Options
- Combined oral contraceptives like Yaz, Yasmin, or Lo Loestrin Fe taken continuously (skipping the placebo week)
- Progestin-only options such as the Mirena IUD (releasing levonorgestrel directly into the uterus for up to 7 years), Nexplanon implant (etonogestrel, effective for 3 years), or Depo-Provera injections (medroxyprogesterone acetate, given every 3 months)
These methods work by thinning the uterine lining, reducing inflammation, and sometimes suppressing ovulation, which helps minimize the growth and bleeding of endometriotic tissue. Side effects vary by method but may include irregular bleeding initially, headaches, mood changes, or breast tenderness.
Considerations
It's essential to discuss your specific symptoms, medical history, and preferences with your healthcare provider to determine which option might work best for your situation, as some women respond better to certain hormonal formulations than others. The ACOG recommendations are based on Level A (good and consistent) scientific evidence, which suggests that treatment with a GnRH agonist for at least three months or with danazol for at least six months appears to be equally effective in most women 1.
Additional Recommendations
When relief of pain from treatment with a GnRH agonist supports continued therapy, the addition of add-back therapy reduces or eliminates GnRH-induced bone mineral loss without reducing the efficacy of pain relief 1. Therapy with a GnRH agonist is an appropriate approach to the management of the woman with chronic pelvic pain; even in the absence of surgical confirmation of endometriosis, provided that a detailed initial evaluation fails to demonstrate some other cause of pelvic pain 1.
For pain relief, oral contraceptives and oral or depot medroxyprogesterone acetate are effective in comparison with placebo and may be equivalent to other more costly regimens 1. Hormone replacement therapy with estrogen is not contraindicated following hysterectomy and bilateral salpingo-oophorectomy for endometriosis 1.
It's crucial to weigh the benefits and risks of each option and consider individual circumstances to make an informed decision about the best birth control method for managing endometriosis-related pelvic pain.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Endometriosis Pelvic Pain
- Combined hormonal contraceptives (CHCs) have been shown to be effective in reducing endometriosis-related pain, including dysmenorrhea, pelvic pain, and dyspareunia 2
- Progestogens, such as levonorgestrel-releasing intrauterine system (IUS), are also effective in relieving endometriosis-associated pelvic pain 3, 4
- Gonadotropin-releasing hormone (GnRH) agonists can be used to treat endometriosis-related pain, but are often limited by side effects and can only be used for a short duration 5, 6
- GnRH antagonists, such as elagolix, relugolix, and linzagolix, have been shown to be effective in reducing endometriosis-related pain and may offer a new treatment option for women with endometriosis 5
Comparison of Treatment Options
- A study found that progestogen and GnRH agonist (GnRHa) were equally effective in relieving endometriosis-associated pelvic pain, but progestogen was associated with more side effects 3
- Combined oral contraceptive pills (COCPs) were found to be effective in relieving endometriosis-associated pelvic pain, but may not be as effective as progestogen in controlling dysmenorrhea 3
- GnRH antagonists, such as elagolix, have been shown to be effective in reducing endometriosis-related pain and may offer a new treatment option for women with endometriosis, particularly those who are resistant to other treatments 5
Future Perspectives
- New treatment options, such as aromatase inhibitors (AIs), are being developed, but more research is needed to fully understand their effectiveness and safety 6, 4
- Further studies are needed to compare the effectiveness and safety of different treatment options for endometriosis-related pain and to determine the best treatment approach for individual women 4, 2