Birth control pills continue to be a popular and viable option for women with endometriosis attempting to manage endo pain. But when it comes to choosing the best pill, are all birth control pills created equal?
While there haven’t been any absolute findings, some women with endometriosis appear to do better on high progestogenic pills. Progestin is a synthetic hormone that functions like progesterone. High doses of progesterone can limit or stop menstrual bleeding altogether.
“For patients with endometriosis, I tend to select birth control pills that are high progestogenic and more androgenic,” said Dr. Robert N. Taylor, M.D., Ph.D., who is a professor of Reproductive Endocrinology and Infertility at the University of Utah Health. “This seems to suppress endometrial growth more effectively.”
Taylor has recommended several preferred oral contraceptives for patients with endometriosis including Lo Loestrin Fe, which he said maintains good bleeding control, LoSeasonique, which contains lower estrogen and Natazia, a newer oral contraceptive with less potent, more natural estrogen in it as well as Dienogest, a progestin medication which has been used in the treatment of endometriosis.
“I like monophasic pills because each day is a consistent dose,” Taylor said. Monophasic birth control pills deliver the same amount of estrogen and progestin throughout the entire month of pills.
Taylor says birth control can be an effective means of managing or suppressing endometriosis, even in young patients, who aren't ready to consider invasive surgical measures. Still, many of his patients are met with sky-high out-of-pocket costs.
“Finding cost-effective solutions for treating younger patients with endometriosis who tend to be less insured can be challenging. Women with endometriosis spend an average of $10,000 on healthcare annually,” said Taylor, who says he is optimistic about new medications being researched to treat endo. “I’m enthusiastic about getting young endometriosis patients started on birth control pills.
"We don’t have evidence to prove we’re actually protecting their fertility, but theoretically, we like to think it could stop endometriosis from growing. Women taking low estrogen birth control pills have very little bleeding, and it, therefore, reduces endometrial growth.”
Taylor pointed out Aygestin, a progesterone-only pill, has been successful with endometriosis patients in European studies with his Italian colleague Paolo Vercellini.
In a 2017 study “Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills” Dr. Robert Casper also praised progestin-only birth control pills as a viable option for endo women.
“Based on controlled trial data, it appears that women with suspected or confirmed endometriosis may do better with oral progestin-only treatment as the first-line therapy because progestins have demonstrated benefits in reducing pain and suppressing the anatomic extent of endometriotic lesions,” Casper published in his study. “Oral progestins alone can be used at any age, do not increase the risk of thrombosis and are capable of inhibiting ovulation and inducing amenorrhea with very few side effects.”
Progesterone therapy also controls pain in around 75 percent of women with endometriosis because the endometrial tissue doesn't thicken as much without estrogen and progestin-only pills do not contain any estrogen, according to Endometriosis.org.
