The Best Birth Control for Endometriosis

Hormonal birth control methods are an effective treatment for endometriosis symptoms. The right one for you depends on factors like your age and overall health, but one thing is universal: Continuous use of whatever birth control option you choose is best for endometriosis.

These treatments stop the ovaries from producing key hormones, including estrogen, which can slow the growth of the uterine lining (endometrium) and prevent new lesions. This can reduce endometriosis symptoms like pelvic pain and heavy bleeding (dysmenorrhea).

Hormonal contraceptives contain either progestin, estrogen, or both. They are available in pill, IUD, vaginal ring, patch, injection, and implant forms.

This article discusses the continuous use of birth control for endometriosis and what hormonal birth control options are either approved or used off-label for this purpose.

Continuous Birth Control Is Best For Endometriosis

Hormonal contraceptives are thought to be most effective for endometriosis when they are used continuously—in other words, without a break in hormone dosing—causing periods to stop. This is true whether they contain estrogen and progesterone or are progestin-only.

Eliminating periods is helpful for women with endometriosis because symptoms tend to be worse during menstruation. It is also believed that endometriosis can be caused or worsened by menstrual tissue that flows backward through the fallopian tubes and then implants in the abdominal cavity.

Some options, like hormonal IUDs, provide consistent hormones. Modified use of the pill, vaginal ring, and patch can do the same.

Instead of following the hormone-free week built into the dosing schedule, during which you would have a light period, you use your birth control daily. This suppresses menstruation entirely.

Birth Control Pills

Birth control pills are available as combination pills (containing estrogen and progestin) or progestin-only. Different brands are available in different dosages.

The pill can help with endometriosis pain because it can make periods shorter or lighter or even eliminate them altogether. It also thins the endometrial lining.

Continuous birth control pills like Lybrel or Seasonique may also offer an additional benefit: the elimination or reduction of periods and associated dysmenorrhea linked to endometriosis.

Hormonal IUDs

The Mirena and Liletta IUDs are thought to help reduce the amount of blood flow during a woman's period, which may help to reduce endometriosis-related pain.

While they are not FDA-approved to treat endometriosis specifically, these IUDs are now FDA-approved to treat heavy periods for up to five years.

Given that these IUDs can be left in place for up to eight years, they can offer the potential to be a long-term endometriosis treatment for women who want to postpone pregnancy.

Skyla, also called the mini-IUD, is another option. Skyla releases the progestin levonorgestrel (14 mcg a day) and lasts for three years. The Skyla IUD is smaller than Mirena and Liletta.

Vaginal Ring

The NuvaRing is a form of contraception that is worn inside the vagina for up to five weeks before needing to be replaced.

While the ring is inserted, your body absorbs the hormones estrogen and progestin through your vaginal lining, which works to stop ovulation. Like other hormonal birth control methods, it can help relieve endometriosis symptoms.

Hormonal Patch

Birth control patches are small adhesive stickers that deliver hormonal contraception through the skin. They contain the same types of hormones as other hormonal birth control methods and, therefore, work to control symptoms of endometriosis.

Xulane is a square patch that contains norelgestromin (progestin) and ethinyl estradiol (estrogen). Twirla is a round patch that contains levonorgestrel (progestin) and ethinyl estradiol.

Hormonal Injections

Depo Provera and Depo-subQ Provera 104 have been shown to reduce pain caused by endometriosis. In 2005, the Depo-subQ Provera 104 injection was approved by the FDA for the treatment of endometriosis-related pain.

Hormonal Implant

Nexplanon is a progestin-only contraceptive implant. A healthcare professional places this rod, which is about the size of a matchstick, under the skin of your upper arm.

Though it is not known precisely how the progestin (etonogestrel) in Nexplanon helps relieve the symptoms of endometriosis, it is thought to work by suppressing the growth of endometrial tissue, thus causing it to gradually diminish.

Progestin may also help reduce the inflammation in the uterus caused by endometriosis, thereby offering some relief from the pain.

The implant protects against pregnancy for three years.

Summary

Hormonal birth control can slow uterine lining growth, reducing endometriosis symptoms such as pain and heavy bleeding. Some options are approved by the FDA for such use. Others are not, though still prescribed off-label.

Continuous use of hormonal birth control—i.e., without a break between dosing—has been found to be most effective for endometriosis.