Hormone treatment is used for endometrial implants and scar removal.
When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis.
Supplemental hormones are effective in reducing or eliminating the pain of endometriosis.
That's because the rise and fall of hormones during menstrual cycle causes endometrial implants to thicken, break down and bleed.

Hormones come in many forms (pills, shots, and nasal sprays):

• Birth control pills (oral contraceptives)
  Most birth control pills contain two hormones, estrogen and progestin.
  This type of birth control pill is called a "combination pill."
  
  They sometimes used to treat endometriosis and help control the effects of natural hormones on endometrial tissue growths on each month.
  So, they prevent the monthly build-up and breakdown of growths.
  Birth control pills also can make a woman's periods lighter and shorter therefore less uncomfortable.
  
  The OCP's work for endometriosis by "fooling" the body into thinking it is pregnant.
  Sometimes women who have severe menstrual pain are asked to take the OCP continuously, meaning skipping the placebo (sugar pill) portion of the cycle.
  Continuous use in this manner will free a woman of having any menstrual periods at all.
  Taking the pill long term can reduce or eliminate the pain of endometriosis. 
  
  No special brand is better than the another brand of OCP for endometriosis treatment.
  OCP's are usually well-tolerated in women with endometriosis.
  • Weight gain,
  • breast tenderness,
  • nausea,
  • irregular bleeding

are usual mild if they occur at all.

Once a woman stops taking them, the ability to get pregnant returns, but so may the symptoms of endometriosis.

• Progestins (progesterone medicines)
  Work much like birth control pills and can be taken by women who can't take estrogen.
  They cause shrinkage of endometrial tissue. 
  The most common progestin used for endometriosis treatment is medroxyprogesterone acetate.
  Side effects, which are reversible with stopping the medication, include
  • breast tenderness,
  • uterine bleeding,
  • depression.

Side effects may decrease with continued treatment.

When a woman stops taking progestins, she can get pregnant again.
But, the symptoms of endometriosis return too.

• Gonadotropin releasing hormone agonists (GnRH agonists)
  These drugs block the production of ovarian-stimulating hormones and slow the growth of endometriosis and relieve symptoms.
  They work alter the hormone levels in the body to reduce the amount of estrogen dramatically in a woman's body, which stops the monthly cycle in a way mimicking menopause and causing endometrial implants to shrink.
  
  Nasal and injection forms of GnRH agonists are available.
  Leuprolide (Lupron®) is a GnRH agonist often used to treat endometriosis.
  Nafarelin (Synarel) and Goserelin (Zoladex) are the other hormone preparates.
  
  These drugs create an artificial menopause that can sometimes lead to troublesome side effects which are a result of the lack of estrogen, such as
  • hot flashes,
  • vaginal dryness,
  • irregular vaginal bleeding,
  • mood changes,
  • fatigue,
  • loss of bone density (osteoporosis).

A low dose of estrogen may be taken along with these drugs to decrease such side effects.
GnRH agonists should not be used alone for more than 6 months; this is because they can lead to osteoporosis.
But if a woman takes estrogen along with GnRH agonists, she can use them for a longer time.
By adding small amounts of estrogen and progesterone (in pill form), a similar aproach to treate menopause, many of the annoying side effects can be avoided.
This is called "add back therapy" and this is the modern way of administering GnRH agonists along with estrogen and progesterone in a way to keep the treatment successful but avoid most of the side effects.

While taking Gn-RH agonists endometriosis goes into remission during the time of treatment but usually the problems of endometriosis also return (sometimes remission continue for months or years afterward).
When a woman stops taking this medicine, monthly periods and the ability to get pregnant return.
 

• Danazol (Danocrine)
  Nowadays, doctors rarely recommend this hormone for endometriosis.
  
  Danazol is a weak male hormone; it
  • blocks the production of ovarian-stimulating hormones and causing anovulation;
  • prevents production of estrogen and progesterone, and lowers the levels in a woman's body, prevents menstruation;
  • suppresses the growth of the endometrium and endometrial implants

therefore relieve the symptoms of endometriosis.
This stops a woman's period or makes it come less often.
Danazol also gives pain relief.

But it often causes side effects like

• unwanted hair growth,
• mood changes,
• voice deepening,
• unfavorable cholesterol changes,
• oily skin,
• weight gain,
• tiredness,
• smaller breasts,
• hot flashes.

Rarely, serious liver damage can occur.
The voice changes and liver damage may not be reversible with halting of the medication use.

Danazol does not prevent pregnancy and can harm a baby growing in the uterus.
Since it can't be used with other hormones, like birth control pills, doctors recommend using condoms, diaphragms, or other "barrier" methods to prevent pregnancy.

• Medroxyprogesterone (Depo-Provera)
  This is an injectable depot drug and is effective in halting menstruation and the growth of endometrial implants, thereby relieving the signs and symptoms of endometriosis.
  Its side effects can include weight gain and depressed mood.
   
• Aromatase inhibitors.
  These agents, are used in breast cancer treatment, and may be useful for endometriosis.
  They work by
  • blocking the conversion of hormones such as androstenedione and testosterone into estrogen
  • blocking the production of estrogen from endometrial implants themselves.

This deprives endometriosis tissue of the estrogen it needs to grow.
Aromatase inhibitors are at least as good as other hormonal approaches and may be better tolerated.

Hormone treatment is best for women with small growths who don't have bad pain.
However, only women who do not wish to become pregnant can use these drugs.

If hormonal therapy has little to no effect on your symptoms, consider questioning the diagnosis of endometriosis.

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