Birth control is often prescribed as the first line of treatment for the many people who experience intense period pain, menstrual issues, and/or endometriosis.   

The same mechanisms within birth control that reduce the risk of pregnancy help stop common endometriosis symptoms, such as pelvic pain, cramping, discomfort during sex and pain while having a bowel movement.

Doctors typically prescribe birth control for women with both mild and severe symptoms, but only after over-the-counter pain relievers (e.g., Tylenol or Ibuprofen) and other measures have been tried. These might include placing a heating pad or hot water bottle on the pelvis area to relax muscles, taking a warm bath, and performing regular gentle movement, such as yoga.  

While the intention of birth control for pain relief is noble, finding the right treatment is often a long and exhausting process. It can require multiple visits to your doctor and a lot of trial and error. 

Let’s explore why birth control can curb endometriosis pain, and how you can fast track to finding what works best for you. 

How hormonal birth control helps with endometriosis symptoms

While hormonal birth control doesn’t cure endometriosis, it can very effectively ease symptoms and improve your quality of life.

Suppression of the cycling hormones, and hopefully prevention of bleeding, can be very effective in improving pain – especially pain with periods.  Eliminating periods hormonally can eliminate the pain associated with bleeding episodes.

The estrogen and progesterone released from the ovaries during a menstrual cycle can cause endometriosis and adenomyosis tissue to grow and generate their own nerve and blood supply. This leads to inflammation and irritation, which send pain signals to the brain. Hormonal birth control stops ovulation and its cascade of hormones to keep the endometrial lining thin and inactive.

Think of it like a bee’s nest that isn’t being provoked.  Using the pills continuously, meaning you skip the week of inactive pills and going straight into the next package, will be optimal for avoiding regular bleeding. 

Additional benefits of birth control pills include the following: 

• Reduced inflammation and pelvic pain/discomfort 
• Fewer episodes of cramping, nausea, and bloating
• Lighter and shorter periods or no periods at all
• Less pain during sex and bowel movements
• Lower risk for certain cancers especially ovarian and uterine cancer
• Reduced hormonal acne

Trialing birth control

While the science and medical communities know a lot about hormonal birth control, understanding how the treatment will affect a specific individual is still variable.

For some women, pain relief is immediate with no complications or side effects. For others, the treatment doesn’t touch the pain and/or there’s unwanted side effects, such as headaches, breast tenderness, nausea, increased blood pressure, and mood changes. [1]

Unfortunately, there’s no easy test to determine who will or who won’t tolerate hormonal birth control as a means of controlling pain. In fact, the research on why some people experience side effects and some don’t is lagging because of the lack of resources being directed to this area of study. 

Many women throw in the proverbial towel and give up if their first birth control causes side effects. Who can blame them? Trading in one pain for another can be scary, frustrating, and take away hope for a better quality of life.  

But, for many who decide to march through trial and error with birth control, hope and symptom relief is very achievable. 

Working with your doctor

Most doctors follow similar paths to starting someone on birth control for pain management. The first option is a “combined” oral contraceptive, which is a once-a-day pill that contains both estrogen and progesterone. This combination or hormones may also be delivered via a vaginal ring or a patch. 

If those options don’t agree with your body, the second option your doctor will likely suggest is progestins and/or hormonal IUDs. Progestins come in both pill form and injection form. IUDs are T-shaped devices that are inserted into the uterus—and eventually removed—to deliver a small dose of progesterone to the uterus without significant blood levels.  

If a form of hormonal birth control worked for you in your 20s, it’s possible that the same form may impact you differently a decade or two later. Keep an open mind when it comes to how your course of hormonal birth control might need to change for pain management. 

When it is not an option

While your doctor is an expert, so are you when it comes to how you feel and how you react to medications. You know your body, your lifestyle, and your preferences better than anyone. That means you have the right to decline any treatment option your doctor presents.

If you can’t take birth control for religious or medical reasons, you can explore pain management alternatives with your doctor. These might include non-hormonal options such as:

• Pelvic floor relaxation exercises and gentle movement
• Dietary changes to reduce inflammation in your body
• Cognitive behavioral therapy 
• Local heat, or the application of TENS (transcutaenous electrical nerve stimulation) devices can be highly effective

There are also surgical interventions for menstrual pain. Of course, surgery has its own long list of benefits and risks. This option should be thoroughly explored with your doctor, and ideally, with another trusted doctor who can give you a second opinion. 

Your course of action 

While starting and finding the right hormonal birth control for endometriosis may require trial and error, there are steps you can take to navigate this a little faster and with less frustration. Consider discussing the following with your doctor:

• Your medical history, including if you experience migraines, high blood pressure, or blood clots. Some birth control options can impact these conditions. 
• Medications you’re taking, including any vitamins or supplements. Some forms of birth control can interact with these outside variables.
• Any prior experience with birth control. How did it affect you both physically and mentally?
• Your lifestyle habits. How active are you? Do you smoke? Do you consume alcohol? 
• Your expectations. How would you like hormonal birth control to help with your pain and to what level? Ask your doctor what expectations he/she has for the options presented to you.
• Potential side effects. Knowing what they are and how long they could last can be helpful in deciding which option(s) may be right for you. 
• How to use hormonal birth control safely and effectively. Collaborate with your doctor and pharmacist to determine this.
• When and if a follow-up appointment is needed while you’re on hormonal birth control. 
• The best way to get in touch with your doctor and care team, if needed, in the time before your next appointment. 

After all, one of the keys to finding the right kind of hormonal birth control is to find a doctor that recommends what works best for you, instead of what works for most.

Getting that kind of personalized care comes down to giving your doctor the most accurate information about your health and being prepared to ask the right questions. 

In that sense, you’re in control, even during those hard times when your pain feels out of control.