Endometriosis - hormone therapy overview

Endometriosis is an estrogen dominant condition which means that estrogen and progesterone (sex hormones which regulate our period) are out of balance.  Estrogen  is essential for normal reproductive development in women.  Our ovaries make most of the estrogen hormones although fat cells and adrenal glands can also produce small amounts.  It is thanks to estrogen that our breasts grow, and our hips become wider. It plays a role in bone development and hair growth, and it also helps to regulate the menstrual cycle, so it has a role to play in getting pregnant.  Estrogen can also affect our mood.

A type of estrogen called estradiol regulates the growth of endometrium (the lining of the uterus).  In endometriosis, endometrium found in the uterus starts to grow elsewhere in the abdomen. High levels of estradiol can lead to following symptoms:

• breast tenderness

• fatigue

• nausea

• vomiting

• headache

• excessive vaginal bleeding

• skin rash

• brain fog

• weight gain around waist, hips, and thighs

• low sex drive

• anxiety

• depression

In addition, high levels of estradiol can contribute to following conditions:

• PCOS (polycystic ovary syndrome)

• breast cancer

• non cancerous lumps in breasts

• uterine cancer

• fibroids (non cancerous uterus growths)

• endometriosis

Your GP can test your hormone levels with a blood or urine sample.

Hormone treatments can alleviate the severity of the symptoms associated with endometriosis.  They can be prescribed in the form of a pill, an injection, and a nasal spray.  Your doctor could prescribe one of the following hormone treatments:

Oral contraceptives or birth control pills

The therapy contains two hormones: estrogen and a progesterone like hormone called progestin.  If a woman is at risk of cardiovascular disease or blood clots, progestin-only pills could be prescribed to ease the menstrual flow and reduce pain.  A woman takes the hormone containing pill for 21 days, followed by sugar pills for 7 days to mimic the normal menstrual cycle.  In some cases, women will take the hormone containing pills continuously, without worrying about the sugar pills in which case the period may stop altogether.  In some cases, sugar pills may be taken only for a couple of days every three months which helps to reduce or eliminate the pain associate with endometriosis.

It is important to emphasise that oral contraceptives do not cure endometriosis - they suppress it, so to speak.  When treatment stops, endometriosis symptoms may return.  Some side effects  of taking oral contraceptives may include weight gain, bloating or bleeding between periods.

Progesterone and progestin

They can be taken as a pill, by injection or through IUD.  They improve  symptoms associated with endometriosis by either reducing or stopping the period. This would prevent pregnancy from occurring. 

An IUD can also be inserted - when it contains progestin, it may ease the pain associated with endometriosis in addition to reducing menstrual flow as well as the size of lesions.  If you decide to go for this option, you need to be aware that one third of women do not longer get their periods after a year of use.

If taken by injection, these hormones will initially reduce the menstrual flow during the first year of use after which menstruation can stop altogether.  After stopping the injections, the period usually returns after a couple of months.  It's important to emphasise that woman can still get pregnant on this kind of hormone therapy.  Side effects may include depression, weight gain or irregular vaginal bleeding.

Gonadotropin-releasing hormone (GnRH) therapy

This kind of hormone therapy is a modified version of gonadotropins which are hormones produced by the pituitary gland which stimulates gonads (testes and ovaries) to increase the production of sex hormones and stimulate production of sperm and ova (eggs).   Main gonadotropins are follicle stimulating hormone (FSH) and luteinizing hormones (LH).

This kind of hormone therapy sends the body into a menopausal state. They can be taken in a low or high dose as a pill.  The low dose pill should not be taken for more than 24 months, and the high dose pill should not be taken for more than 6 months as it may cause bone loss and/or heart complications. 

GnRH can also be taken as a nasal spray or as an injection. The most common side effects are depression, joint pain, headaches, nausea, difficulty sleeping, and absence of periods.  After stopping the GnRH treatment, the body comes out of the menopause, the menstrual cycle resumes, and pregnancy is possible.  As with all hormonal treatments, endometriosis symptoms tend to return after the treatment is stopped.

It's very important that women ask their doctor to discuss all of the options thoroughly, so that they could make an informed decision.  Considering how hormones can affect us both physiologically and psychologically, it's important to consider all sorts of treatments, including herbal medicine.  Your doctor may know very little about herbalism.  Therefore, a woman should see a knowledgeable herbalist for more information.  As I've mentioned in other blogs, the reproductive system is quite responsive to herbal treatments with regards to chronic conditions such as endometriosis.