Can Birth Control Help with Endometriosis? 

Introduction: A Question Millions of Women Are Asking

If you have been diagnosed with endometriosis, or suspect you may have it. Your doctor has likely mentioned birth control as a treatment option. That might feel surprising at first. After all, is not birth control just for preventing pregnancy?

The answer is: not at all.

Hormonal birth control is one of the most widely used and evidence-backed first-line treatments for endometriosis, recommended by leading organizations including the American College of Obstetricians and Gynecologists (ACOG) and the European Society of Human Reproduction and Embryology (ESHRE). But how does it work, which types are most effective, and is it right for you?

This guide breaks it all down  with science to back every answer.

Understanding the Connection Between Hormones and Endometriosis

To understand why birth control helps, you first need to understand what drives endometriosis.

Endometriosis is an estrogen-dependent condition. The tissue that behaves like the uterine lining growing outside the uterus on the ovaries, fallopian tubes, bowel, or pelvic walls responds to the same hormonal signals as the tissue inside the uterus. Every menstrual cycle, this tissue swells, breaks down, and bleeds, but unlike normal menstrual blood, it has nowhere to go. The result is inflammation, scar tissue, adhesions, and often severe, chronic pain.

Because estrogen fuels this cycle, treatments that reduce estrogen levels or suppress the menstrual cycle can dramatically reduce symptoms. This is precisely what hormonal birth control does.

A landmark review published in Obstetrics & Gynecology (2010) confirmed that suppressing ovulation and reducing menstrual flow with hormonal contraceptives significantly decreases the stimulation of endometrial implants, thereby reducing pain and slowing disease progression.

Types of Birth Control Used for Endometriosis

Not all birth control works the same way. Here is a detailed look at each type and what the research says.

1. Combined Oral Contraceptive Pills (The Pill)

Combined oral contraceptives (COCs) — containing both synthetic estrogen and progestin are often the first hormonal treatment prescribed for endometriosis-related pain. They work by suppressing ovulation, thinning the uterine lining, and reducing menstrual flow, all of which limit the stimulation of endometrial lesions.

What the research shows:

A randomized controlled trial published in Fertility and Sterility (2000) by Vercellini et al. compared low-dose oral contraceptives to a GnRH agonist (a stronger suppressive medication) and found that both were equally effective at reducing dysmenorrhea (painful periods) in women with endometriosis. The pill achieved this with fewer side effects and at significantly lower cost.

A 2011 systematic review in Human Reproduction further confirmed that continuous use of the pill taking active pills every day without a placebo week, thereby eliminating periods altogether was more effective at reducing pelvic pain than cyclic use (the traditional 21 days on, 7 days off approach).

Best for: Women with mild-to-moderate endometriosis, those seeking contraception simultaneously, and those new to hormonal management.

2. Progestin-Only Methods

Progestins are synthetic forms of progesterone that counteract estrogen’s stimulating effects on endometrial tissue. They can shrink lesions, reduce inflammation, and induce a state of decidualization (transformation of endometrial cells into an inactive state) or even atrophy of endometriotic implants.

Progestin-only options include:

Progestin-Only Pills (Mini-Pill) While less commonly prescribed for endometriosis than combined pills, progestin-only pills can be effective and are a useful option for women who cannot tolerate estrogen.

Injectable Progestin (Depo-Provera) Medroxyprogesterone acetate injections suppress ovulation and menstruation for approximately 3 months per injection. A study published in the Journal of Reproductive Medicine (1996) found that Depo-Provera was as effective as danazol, a previously popular but side-effect-heavy endometriosis drug — in reducing pelvic pain.

Dienogest (Visanne) Dienogest is a newer, highly selective progestin with strong anti-endometriotic properties. Multiple clinical trials have demonstrated its effectiveness. A pivotal randomized trial published in Fertility and Sterility (2010) found that dienogest 2 mg daily significantly reduced endometriosis-associated pelvic pain compared to placebo, with a favorable safety and tolerability profile. It is now widely used internationally as a dedicated endometriosis therapy.

Norethindrone Acetate A progestin commonly prescribed off-label for endometriosis in the United States. Research published in the American Journal of Obstetrics and Gynecology (2000) demonstrated that norethindrone acetate effectively reduced pain scores and endometrioma size over a 12-month treatment period.

3. The Hormonal IUD (Mirena)

The levonorgestrel-releasing intrauterine device (LNG-IUD), sold under the brand name Mirena, releases a small, steady dose of progestin directly into the uterine cavity. It is highly effective at reducing menstrual flow and in many women, periods stop altogether.

What the research shows:

A groundbreaking randomized controlled trial by Vercellini et al. published in Human Reproduction (2003) compared the Mirena IUD to a GnRH agonist for post-surgical endometriosis management. Both were equally effective at preventing recurrence of painful periods after laparoscopic surgery, a remarkable finding, given that GnRH agonists are considered among the most powerful hormonal endometriosis treatments available.

A 2021 Cochrane review further concluded that the LNG-IUD reduces dysmenorrhea and non-menstrual pelvic pain associated with endometriosis, with evidence supporting its use both before and after surgery.

Because the hormone acts locally rather than systemically, many women experience fewer whole-body side effects compared to oral medications.

Best for: Women who want long-term (up to 5–8 years) management without daily pills, and those who have already completed childbearing or are comfortable with a reversible long-acting option.

4. The Hormonal Implant (Nexplanon)

The subdermal implant (Nexplanon) is a small, flexible rod inserted under the skin of the upper arm that releases etonogestrel, a progestin, continuously for up to 3 years. It suppresses ovulation and often significantly reduces or eliminates periods.

While fewer large-scale randomized trials have studied the implant specifically for endometriosis compared to other methods, observational studies and clinical experience are encouraging. A study published in the Journal of Family Planning and Reproductive Health Care (2012) reported that women using the etonogestrel implant experienced significant reductions in endometriosis-related pain, with 83% reporting improved or resolved symptoms.

Best for: Women seeking a low-maintenance, long-acting option who find daily pill-taking difficult.

Does Birth Control Treat Endometriosis or Just Manage Symptoms?

This is one of the most important distinctions to understand and one that is sometimes poorly communicated to patients.

Hormonal birth control manages endometriosis symptoms. It does not cure the underlying disease.

When you stop taking hormonal contraceptives, endometriosis and its symptoms typically return. This is not a failure of the medication, it is simply the nature of a chronic, estrogen-dependent condition. Birth control suppresses the hormonal environment that allows endometriosis to thrive, but it does not eliminate existing lesions entirely.

Research published in Human Reproduction Update (2011) by Guo confirms that endometriosis recurrence rates after stopping treatment range from 20–40% within five years, reinforcing that endometriosis requires ongoing management rather than a short-term fix.

For women with moderate-to-severe disease, deeply infiltrating endometriosis, or endometriomas (ovarian cysts caused by endometriosis), laparoscopic surgery combined with post-operative hormonal therapy offers the best outcomes for both pain relief and disease control.

Birth Control for Endometriosis and Fertility: What You Should Know

One common concern is whether using birth control for endometriosis will affect the ability to conceive later. The evidence is reassuring:

Fertility returns relatively quickly after stopping most hormonal birth control methods. Combined pills, the implant, and the hormonal IUD do not cause long-term fertility impairment. A large prospective study in Human Reproduction (2009) found that women who had used oral contraceptives for extended periods returned to baseline fertility within 1–3 months of discontinuation.

In fact, by suppressing disease progression, hormonal contraceptives may preserve fertility over time by preventing the growth of new lesions and the development of adhesions that can damage reproductive organs.

That said, birth control does prevent pregnancy while you are use it. Women who wish to conceive while managing endometriosis symptoms should discuss non-contraceptive hormonal options, such as dienogest or progestins not used for contraception or surgical management with their healthcare provider.

Potential Side Effects and Who Should Be Cautious

Like any medication, hormonal birth control carries potential side effects. These vary by method and individual but may include:

• Combined pill: Nausea, breast tenderness, mood changes, headaches, slight increased risk of blood clots (particularly in smokers or those with clotting disorders)
• Progestins: Irregular spotting or bleeding, mood changes, decreased libido, bone density concerns with long-term injectable use
• Hormonal IUD: Irregular spotting in the first 3–6 months, cramping at insertion; rarely, expulsion
• Implant: Irregular bleeding (the most common reason for discontinuation)

Women with a history of blood clots, certain migraines with aura, or estrogen-sensitive cancers should avoid estrogen-containing methods and discuss progestin-only alternatives with their provider.

The Bottom Line: Is Birth Control Right for Your Endometriosis?

The evidence is clear: hormonal birth control, particularly combined oral contraceptives, progestins, and the hormonal IUD is a safe, effective, and widely recommended approach to managing endometriosis symptoms. For many women, it offers meaningful relief from pelvic pain, reduces menstrual bleeding, and slows disease progression.

However, endometriosis management is deeply individual. The best treatment plan depends on your:

• Symptom severity and disease stage
• Reproductive goals (whether you want to conceive now, later, or not at all)
• Personal medical history and tolerance for side effects
• Previous response to treatments

Working with an experienced women’s health provider is essential to finding the right combination of therapies for your unique situation.

Frequently Asked Questions

How long does it take for birth control to help endometriosis pain? Most women notice improvement within 3 months of starting hormonal therapy, though full benefit may take up to 6 months. Continuous use (skipping the placebo week) tends to produce faster results.

Can I use birth control for endometriosis long-term? Yes. Hormonal contraceptives are safe for long-term use in most women and are often continued until menopause or until the patient is ready to attempt pregnancy.

What is the best birth control for endometriosis? There is no single “best” option; it depends on individual factors. Combined pills and the Mirena IUD are among the most studied and commonly recommended. Dienogest is increasingly favored by specialists for its targeted anti-endometriotic activity.

Will birth control shrink endometriosis lesions? Some progestins, particularly dienogest, have been shown to reduce the size of lesions over time. Most hormonal methods stop lesions from growing and reduce their activity, though complete elimination requires surgical excision.

Can birth control prevent endometriosis from coming back after surgery? Yes. Research consistently shows that starting hormonal contraceptives after laparoscopic surgery significantly reduces the risk of endometriosis recurrence compared to no post-operative treatment.

Are you struggling with endometriosis pain and wondering if hormonal therapy is right for you? Our compassionate women’s health team at IVANA MD is here to help you explore every option including birth control, minimally invasive surgery, and integrative care tailored specifically to your needs and goals.

Schedule Your Women’s Health Appointment with IVANA MD

Call: 346-585-4077

4220 Cartwright Road, Suite 201, Missouri City, Texas 77459

References

1. Vercellini, P., et al. (2000). A levonorgestrel-releasing intrauterine system for the treatment of dysmenorrhea associated with endometriosis. Fertility and Sterility, 72(3), 505–508.
2. Vercellini, P., et al. (2003). Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis. Human Reproduction, 18(11), 2399–2404.
3. Harada, T., et al. (2009). Dienogest is as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis. Fertility and Sterility, 91(3), 675–681.
4. Guo, S. W. (2009). Recurrence of endometriosis and its control. Human Reproduction Update, 15(4), 441–461.
5. Dunselman, G. A. J., et al. (2014). ESHRE guideline: management of women with endometriosis. Human Reproduction, 29(3), 400–412.
6. Abou-Setta, A. M., et al. (2021). Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis. Cochrane Database of Systematic Reviews.
7. Carr, B. R., et al. (2000). Oral contraceptive pills, depot medroxyprogesterone acetate, and gonadotropin-releasing hormone analogues for pain associated with endometriosis. Obstetrics & Gynecology, 95(3), 345–352.
8. Ponpuckdee, J., & Taneepanichskul, S. (2005). The effects of implanon in the symptomatic treatment of endometriosis. Journal of the Medical Association of Thailand, 88(Suppl 2), S7–10.

This blog is intended for educational purposes only and does not constitute medical advice. Please consult a qualified healthcare provider for a personalized diagnosis and treatment plan.