Debunking Sex Health: Endometriosis & Birth Control—What Really Works?

The recommended way to use any combined hormonal birth control method for endometriosis is to use it continuously and skip periods to avoid the pain that often comes with menstrual cycles.

Not All Birth Control is Created Equal

If you've experienced agonizing period pain that has you canceling plans, popping painkillers like candy, or curling up with a heating pad for days, you might be dealing with more than just "bad cramps." When period pain disrupts your life month after month, endometriosis could be the culprit.

Despite affecting about 10% of people with uteruses worldwide (that's 190 million people!), endometriosis remains widely misunderstood and often goes undiagnosed for years. One common question we hear at Twentyeight Health is whether birth control can actually help manage this challenging condition.

Let's set the record straight on endometriosis and explore how hormonal birth control might fit into your treatment plan.

What's Really Happening With Endometriosis?

Endometriosis is when tissue similar to your uterine lining (endometrium) grows where it shouldn't—outside your uterus. This rogue tissue can show up on your ovaries, fallopian tubes, and the tissue lining your pelvis.

Here's the problem: this tissue acts just like regular uterine lining—it thickens, breaks down, and bleeds with your menstrual cycle. But unlike your period blood which exits your body, this blood has nowhere to go. This trapped blood irritates surrounding tissue, eventually causing scarring and adhesions—bands of fibrous tissue that can cause organs to stick together.

The Reality of Endometriosis Symptoms

Endometriosis isn't just "bad periods." The symptoms can be wide-ranging and seriously impact your quality of life:

• Intensely painful periods that go beyond normal cramping
• Deep pain during sex that might linger for hours or days afterward
• Lower back and abdominal pain that can occur throughout your cycle
• Heavy menstrual bleeding or bleeding between periods
• Pain with bowel movements or urination, especially during your period
• Fatigue, diarrhea, constipation, bloating or nausea, particularly during menstrual periods
• Difficulty getting pregnant due to scarring and inflammation

It's important to know that symptoms vary widely—some people with severe endometriosis might have minimal pain, while others with milder cases can experience debilitating symptoms.

[Connect with a provider who understands endometriosis →] Pain shouldn't rule your life.

The Birth Control Connection: Can It Really Help?

Birth control is often one of the first treatment options suggested for endometriosis symptoms—but does it actually work?

The Truth: Birth Control Can Help Manage Symptoms

While birth control isn't a cure for endometriosis, it can be an effective way to manage symptoms for many people. Here's how it works:

• Hormonal birth control methods help regulate or even stop your periods
• Less bleeding means less pain since there's less tissue to shed and become inflamed
• Continuous use (skipping the placebo/break week) can prevent periods altogether
• Anti-inflammatory effects of certain hormones may reduce endometriosis-related inflammation

Different types of hormonal birth control may work better for different people with endometriosis:

• Combined hormonal contraceptives (pills, patch, ring) containing both estrogen and progestin can reduce pain and bleeding
• Progestin-only options like the hormonal IUD, implant, or minipill may be particularly effective since progestins thin the uterine lining
• Continuous use methods that reduce or eliminate periods often provide the most relief

For mild symptoms, over-the-counter pain relievers and hormonal contraception methods can help reduce symptoms. For more severe symptoms, other medications and surgeries may be options.

Beyond Birth Control: The Full Treatment Picture

While birth control can be helpful, it's just one piece of the endometriosis treatment puzzle. A comprehensive approach might include:

• Pain management with over-the-counter or prescription pain relievers
• Hormone therapy beyond birth control, such as GnRH agonists that create a temporary menopause-like state
• Surgical options to remove endometriosis tissue, which can provide significant relief
• Lifestyle modifications like anti-inflammatory diets, stress reduction, and exercise
• Physical therapy specialized for pelvic pain
• Complementary approaches like acupuncture or yoga that some find helpful

[Birth control shouldn't be complicated. Find options that fit your body and help manage endo symptoms →]

The Fertility Question

One of the most concerning aspects of endometriosis for many people is its potential impact on fertility. About 30-50% of people with endometriosis may experience infertility.

Endometriosis tissue is most commonly found near the ovaries and the fallopian tubes. With time, the inflammation caused by endometriosis can cause the fallopian tubes to become scarred and blocked.

However, having endometriosis doesn't automatically mean you can't get pregnant:

• Many people with mild-to-moderate endometriosis conceive without assistance
• Surgical treatment can improve fertility rates for some
• Fertility treatments like IVF can bypass blocked fallopian tubes
• Early diagnosis and treatment may help preserve fertility

It's important to have open conversations with your healthcare provider about your fertility goals, especially when discussing treatment options like birth control.

Getting Diagnosed: The Path Forward

The journey to an endometriosis diagnosis can be frustratingly long—on average, it takes 7-10 years from symptom onset to diagnosis. This delay often happens because:

• Period pain is normalized or dismissed
• Symptoms overlap with other conditions
• Some healthcare providers lack familiarity with the condition
• The definitive diagnosis requires surgery (though this is changing)

A doctor will typically:

1. Take a detailed history of your symptoms
2. Perform a physical exam, including a pelvic exam
3. Order imaging tests like ultrasound or MRI
4. Possibly recommend laparoscopic surgery to confirm the diagnosis and remove tissue

‍Living Well With Endometriosis

While there's no known way to prevent endometriosis, and we don't yet have a cure, you can take steps to live well with this condition:

• Find the right healthcare team who takes your pain seriously
• Explore treatment options until you find what works for your body
• Connect with support groups like the Endometriosis Foundation of America
• Track your symptoms to identify patterns and triggers
• Prioritize self-care during flare-ups
• Be open with partners about how endometriosis affects intimacy
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[Take control of your endometriosis journey. Schedule a consultation with our caring providers →]

Endometriosis is a complex, chronic condition—not just "bad periods" that you should tough out. Birth control can be an effective tool for managing symptoms, particularly when used continuously to reduce or eliminate periods. However, it's just one option in a broader treatment approach.

The most important thing to remember is that your pain is real, you deserve relief, and effective treatments are available. At Twentyeight Health, we believe in providing compassionate care that addresses your unique needs and helps you navigate this challenging condition.

Have questions about managing endometriosis or finding the right birth control to help with symptoms? Our providers are ready to listen and help you explore your options.