Birth Control for Endometriosis and Fibroids
Birth control pills and hormonal IUDs are effective first-line treatments that reduce pain and heavy bleeding in approximately two-thirds of women with endometriosis and fibroids by suppressing hormonal fluctuations and thinning the uterine lining. 1, 2
How Birth Control Works for Your Conditions
For Endometriosis
- Combined oral contraceptives (birth control pills) reduce endometriosis pain by suppressing ovulation and creating a stable hormonal environment that prevents the growth of endometrial tissue outside your uterus 3, 4
- Birth control pills specifically help with menstrual cramps (dysmenorrhea), pelvic pain between periods, and pain during intercourse (dyspareunia) 3, 5
- The FDA recognizes that birth control pills decrease menstrual pain and regulate your cycle, which directly addresses endometriosis symptoms 6
For Fibroids
- Birth control pills and hormonal IUDs are recommended as first-line medical treatment to reduce heavy menstrual bleeding caused by fibroids 1, 2
- The levonorgestrel IUD (hormonal IUD) is particularly effective because it works locally in the uterus with minimal systemic hormones and lasts for years after a single placement 1
- Combined oral contraceptives help control bleeding and pain from fibroids, though they won't shrink the fibroids themselves 2
What to Expect
Effectiveness
- About 65-70% of women experience significant symptom relief with birth control for endometriosis 4
- For fibroids, birth control effectively controls bleeding in most women, though it doesn't reduce fibroid size 1, 2
- If you're in the one-third of women who don't respond well to birth control (often due to "progesterone resistance"), other medications like GnRH antagonists are available 4
Choosing Between Options
- The hormonal IUD is clinically preferred over birth control pills for fibroid-related bleeding because it delivers hormones directly to the uterine lining, has fewer side effects, and you don't have to remember daily pills 1
- A recent trial showed the hormonal IUD provides better pain and bleeding control than birth control pills in women with adenomyosis (a related condition), suggesting similar benefits may apply 1
- Birth control pills remain an excellent option if you prefer oral medication or need contraception 2, 3
Important Considerations
When Birth Control May Not Be Enough
- Birth control only treats symptoms—it doesn't eliminate endometriosis or shrink fibroids 2, 7
- If you have large fibroids causing pressure symptoms (bladder pressure, pelvic fullness, bowel changes), birth control won't address these "bulk symptoms" and you may need other treatments 1
- If birth control fails to control your symptoms after 3-6 months, discuss alternative medications like GnRH antagonists (relugolix) or procedures with your doctor 8, 4
Additional Benefits
- The FDA notes that long-term birth control use decreases your risk of ovarian cancer and endometrial cancer 6
- Birth control also reduces the formation of ovarian cysts and decreases the risk of ectopic pregnancy 6
Side Effects to Monitor
- Common side effects include headaches and weight gain with pills 5
- The hormonal IUD may cause irregular bleeding initially, though this typically improves after 3-6 months 1
- Unlike older treatments (GnRH agonists), birth control doesn't cause menopausal symptoms like hot flashes or bone loss 5, 4
The Bottom Line
Start with either combined birth control pills or a hormonal IUD as your first treatment—these are safe, effective, and can be used long-term unlike other hormonal therapies 1, 2, 4. The hormonal IUD offers superior convenience and local hormone delivery, while pills provide more flexibility if you want to stop quickly 1. If symptoms persist after 3-6 months, you're not a treatment failure—you simply need to move to the next step in the treatment algorithm, which includes newer oral medications or minimally invasive procedures 1, 8, 4.