|Generic Name||Brand Name|
|estrogen/progestin combination pills (birth control pills)||Brevicon, Demulen, Levlen, Levora, Lo/Ovral, Modicon, Nelova, Nelova 10/11, Nordette, Norethin 1/35E, Norethin 1/50M, Norinyl, Ortho-Novum, Ovcon, Tri-Levlen, Tri-Norinyl, Triphasil, Seasonale [extended cycle]|
Estrogen/progestin combination pill schedule
one of the following methods:
- Beginning on the fifth day of your menstrual
period, take one tablet daily for 20 or 21 days. This is followed by 7 or 8
days of no medication (you may take sugar pills provided in the pack), during
which you have a menstrual period. You then start a new pack of
- For Seasonale, take the active hormone pills continuously
for 3 months. This is followed by 7 days of sugar pills. You then start a new
pack of pills. If you have bothersome breakthrough bleeding during the 3
months, your health professional may prescribe extra estrogen.
If you prefer, you can use a weekly hormone skin patch or
monthly vaginal ring instead of daily pills.
How It Works
Birth control pills (oral
contraceptives) that contain
progestin are also called "the Pill." Birth control
endometriosis by stopping
ovulation and decreasing the
endometrium's monthly cycle of growing, bleeding, and
shedding. They also affect the endometriosis growths (implants), making them
shrink and bleed less.1
Why It Is Used
Birth control pills are the
first-choice treatment for controlling endometriosis growth and pain. This is
because birth control hormones are the hormone therapy that is least likely to
cause bad side effects. For this reason, they can be used for years, while
other hormone therapies can only be used for several months to 2 years.
Birth control pills can be taken with
nonsteroidal anti-inflammatory drug (NSAID) therapy,
which helps further reduce endometriosis inflammation and pain-causing
Birth control pills can
also be used to stop or further slow endometriosis growths after endometriosis
How Well It Works
Like all hormone therapies and
surgery, birth control hormones do not cure endometriosis. However, they can
relieve endometriosis symptoms and are likely to slow the growth of
Birth control pills improve endometriosis and
menstrual pain and bleeding for most women.2 They are
most effective when used to relieve minimal to mild symptoms.
Continuous use of birth control pills for 84 days (sold as Seasonale) is
likely to give the most relief.3 About one-third of
women who take regular 28-day cycles have pain during the fourth, hormone-free
Using birth control hormones for 5 or more years lowers
ovarian cancer risk (endometriosis increases ovarian cancer risk).4
Oral contraceptives cannot be used to treat
infertility caused by endometriosis. They prevent
After treatment with birth control
hormones or any other hormone therapy,
endometriosis pain can, but does not always,
- Per year, up to 20% of all women treated will
have pain that returns after hormone treatment.
37% of women who use hormone therapy for mild endometriosis have pain 5 years later.
74% of women who use hormone therapy for severe endometriosis have pain 5 years later.
Side effects from oral contraceptives
are usually mild. They may include:
- Changes in menstrual periods, including very
light or skipped periods.
- Slight bleeding between periods
(spotting). This is more common with an extended cycle (Seasonale) but
decreases after 3 to 4 months of use.
- Nausea and vomiting,
especially during the first month of use. This side effect usually goes away
after the first few months of use.
- Frequent or more severe
Migraine headaches may get worse; for some women, they
- Weight gain.
- Breast tenderness for the first
few months of use.
- Depression or mood
- Darkening of the skin on the upper lip, under the eyes, or
on the forehead (chloasma) after sun exposure. This may slowly fade after you
stop using hormonal methods, but in some cases, it is
- Decreased interest in sex.
Possible long-term side effects of extended-cycle hormones
have yet to be studied.6
Report any of
these side effects to your health professional at your next regularly scheduled
Rare but serious side effects
symptoms, called ACHES, are rare but serious and should
be reported to your health professional immediately. The risk of serious side
effects increases in women who smoke and are older than 35.
- Abdominal pain that is
severe or persists may be a sign of blood clots (thrombophlebitis) in the pelvis, liver blood clots or
tumors, or gallbladder disease.
- Chest pain
may be a sign of blood clots in the lungs (pulmonary embolism),
heart attack, or heart disease. Smoking increases this
- Headaches that are severe may be a
hypertension. Smoking increases this
- Eye problems, such as blurred vision
or loss of vision, may be a sign of migraine, blood clots in the eye, or a
change in the shape of the
- Severe leg
pain or sudden swelling of one leg may be a sign of leg blood clots
(thrombophlebitis) or deep vein thrombosis (DVT).
See Drug Reference for a full list of side effects.
(Drug Reference is not available in all systems.)
What To Think About
There is no cure for
endometriosis. However, birth control hormones may slow the long-term growth of
endometriosis. Like all hormone therapies and surgery for endometriosis, birth
control hormones do not reduce symptoms in all women.
If you do
not smoke and have no other risk factors, you can use birth control pills until
menopause. Endometriosis will naturally improve when
your estrogen levels drop after menopause.
generally are not recommended if you have any of the following risk factors for
Complete the new medication information form (PDF)(What is a PDF document?)
to help you understand this medication.
Lobo RA. (2007). Endometriosis. In VL Katz
et al., eds., Comprehensive Gynecology, 5th ed., pp.
473–499. Philadelphia: Mosby Elsevier.
Johnson N, Farquhar C (2006). Endometriosis, search
date April 2006. Online version of Clinical Evidence
Vercellini P, et al. (2003). Continuous use of an
oral contraceptive for endometriosis-associated recurrent dysmenorrhea that
does not respond to a cyclic pill regimen. Fertility and Sterility, 80(3): 560–563.
Modugno F, et al. (2004). Oral contraceptive use,
reproductive history, and risk of epithelial ovarian cancer in women with and
without endometriosis. American Journal of Obstetrics and Gynecology, 191(3): 733–740.
Speroff L, Fritz MA (2005). Endometriosis. In
Clinical Gynecologic Endocrinology and Infertility, 7th
ed., pp. 1103–1133. Philadelphia: Lippincott Williams and Wilkins.
Abramowicz M (2004). Seasonale. Medical Letter on Drugs and Therapeutics, 46(1175):