This decision aid is for women who have mild symptoms and have not yet had laparoscopic surgery to diagnose or treat endometriosis. Hysterectomy and oophorectomy may be an option for women who have severe symptoms and have already tried hormone therapy and laparoscopic surgery.
The endometrium is the tissue that lines the uterus. During each menstrual cycle, a new lining grows, getting ready for a possible pregnancy. If you don't become pregnant during that cycle, the lining sheds. This is your menstrual period.
Endometriosis (say "en-doh-mee-tree-OH-sus") is the growth of this tissue outside of the uterus, usually on the ovaries or the fallopian tubes. It also may grow on the outside surface of the uterus, the bowels, or other organs in the belly.
These growths are called "implants." They grow, bleed, and break down with each menstrual cycle, just like the lining of the uterus does. In some women, this can cause pain and can make it hard to get pregnant.
Sometimes scar tissue forms around implants. This also can cause pain and trouble getting pregnant.
The female hormone estrogen, released by the ovaries, makes the implants grow.
While some women never have symptoms, others have severe pain. In some cases, the problem can affect how well your bowels, bladder, or other organs work.
Pain from implants may be mild for a few days before your menstrual period. It may get better during your period. But if an implant grows in a sensitive area such as the rectum, it can cause constant pain or pain during sex, exercise, or bowel movements.
Symptoms often get better during pregnancy and after childbirth and usually go away after menopause.
You likely will start treatment with birth control hormones. They are usually the safest hormones for long-term use. If they don't help your symptoms, you could take a stronger hormone. And if that one doesn't work, you could try an even stronger hormone. The stronger hormones are used only for a short time, because they have serious side effects.
Hormone therapy reduces estrogen levels in your body. Because of this, you can't use hormone therapy if you want to get pregnant.
Hormones relieve the symptoms of endometriosis for up to 90 out of 100 women. This means that they don't work for 10 out of 100 women.1 You may have to try two or more types of hormones before you find one that works for you.
If taking birth control hormones works for you, you can use them for years (unless you plan to get pregnant).
For some women, hormones work for a while. For others, relief lasts a long time.
After treatment with any hormone therapy, pain may come back.2
These medicines have different side effects and risks. Some of them can make you feel like you're going through menopause.
Your doctor may advise you to try hormones if:
|Take hormones||Don't take hormones|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"The pain before and during my periods was so bad, I couldn't exercise. I am an active person, and the pain was really getting me down. I have had endometriosis for years and have tried ibuprofen and other medicines I could get at the drugstore, but they were not helping anymore. My doctor said taking birth control pills might help me. She said that also taking ibuprofen around the time of my period could really help. After a couple of months, I noticed enough of an improvement that I could do everything I used to. I'm especially happy that I can use this treatment for a long time, unlike other hormone therapies like Lupron."
— Maria, age 45
"I first noticed that my periods were becoming painful about a year ago. I wasn't too concerned, but I discussed the pain with my doctor when I went for a Pap smear. My examination and Pap smear were fine. My doctor said that endometriosis could be the cause of my pain. Since my mom and an older sister have had endometriosis, I wasn't too surprised. My doctor talked to me about my options. She told me that using ibuprofen, such as Advil or Motrin, might help my pain. Now I start taking ibuprofen the day before my period begins. It really helps relieve my pain. As long as ibuprofen helps my pain, I will wait before I try other treatment for my endometriosis."
— Kathleen, age 38
"I was surprised when my doctor told me endometriosis could be the cause of the pain I was having with my periods. I had never heard of endometriosis before. He explained what it was and told me about the treatments I could try. Taking birth control pills didn't help, and my doctor said a medicine called Lupron might stop the pain, though I could only take it for a few months. Treatment with Lupron worked. I hardly have any pain now, and taking a little estrogen for add-back therapy controlled the hot flashes without feeding the endometriosis."
— Hannah, age 29
"My periods were really painful about 5 years ago. I went to my doctor, and he asked a lot of questions about my periods and did a pelvic examination and some tests. When all the tests came back normal, he said endometriosis might be the cause of my pain. I asked if waiting a few months to decide about treatment would be dangerous. He said waiting would be fine. After a few months, the pain eased up. I am glad I decided to wait and see."
— Nancy, age 40
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to use hormone therapy
Reasons not to use hormone therapy
I want to control my pain better.
I get enough pain relief from anti-inflammatory medicines.
I don't want to wait until menopause for my pain to go away.
I want to wait as long as I can before I start using hormones.
I can handle the side effects of hormones for a few months.
I don't want to deal with the side effects of hormones even for a few months.
I want to have a baby, but I'm willing to put off trying to get pregnant for 6 months or a year.
I want to get pregnant in the next year.
My other important reasons:
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Using hormone therapy
NOT using hormone therapy
1. Hormone therapy is a good first choice to treat endometriosis if I don't plan to get pregnant soon.
2. Some hormones can cause side effects that will make me feel like I'm going through menopause.
3. I can take hormone therapy as long as I want to without side effects.
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|