Hormonal treatments may help symptoms for some people with suspected or confirmed endometriosis, but they are not suitable for everyone.

They are often discussed because endometriosis symptoms can be influenced by hormonal changes across the menstrual cycle. Some people find hormonal treatment helpful for pain, bleeding or cyclical flares. Others cannot use it, do not tolerate side effects, do not get enough relief, or do not want treatment that affects their cycle or fertility plans. Hormonal treatment can help manage symptoms, but it does not physically remove endometriosis lesions.

What hormonal treatment may do

Hormonal treatment may aim to:

  • reduce period pain
  • make periods lighter or less frequent
  • reduce bleeding
  • suppress ovulation
  • reduce cyclical symptom flares
  • reduce pain severity or frequency for some people
  • prolong symptom benefit after surgery in some cases

WHO states that hormonal medicines may reduce pain severity or frequency for some people, but treatment choice should consider severity, preferences, side effects, long-term safety, cost, availability and whether pregnancy is desired.

What hormonal treatment does not do

Hormonal treatment does not remove endometriosis lesions, adhesions, scar tissue or endometriomas. It may reduce symptoms while someone is taking it, but symptoms can return after stopping. If pain continues, worsens, spreads, or affects daily life, the care plan should be reviewed. Hormonal treatment should not be used to dismiss symptoms or delay appropriate investigation or referral when symptoms are severe, persistent or complex.

Common types of hormonal treatment

Options may include:

  • combined hormonal contraception, such as the pill, patch or ring
  • progestogen-only treatment, such as tablets, injections or implants
  • hormonal intrauterine systems
  • GnRH agonists or antagonists in selected situations
  • other specialist hormonal medicines in specific cases

Many regulatory medical bodies recommend offering hormonal treatment, such as the combined oral contraceptive pill or a progestogen, to people with suspected, confirmed or recurrent endometriosis, and explains that hormonal treatment can reduce pain and has no permanent negative effect on later fertility.

Combined hormonal contraception

Combined hormonal contraception may be used to reduce bleeding, period pain or cyclical flares. Some people may be advised to take it continuously to reduce or avoid bleeding, depending on their health history and the prescriber’s advice. It may not be suitable for everyone, including some people with migraine with aura, blood clot risk, certain heart or liver conditions, uncontrolled high blood pressure, smoking-related risks over a certain age, or other medical concerns. You should ask what benefits are expected, what side effects to watch for, and whether it is safe for your personal health history.

Progestogen-only treatment

Progestogen-only options may include tablets, injections, implants or hormonal intrauterine systems. They may help reduce bleeding, suppress the cycle, or reduce pain for some people. Side effects can vary and may include irregular bleeding, mood changes, acne, breast tenderness, bloating, headaches or changes in bleeding pattern. Some people tolerate progestogen-only treatment well. Others do not. Side effects should be taken seriously and reviewed.

GnRH medicines

GnRH medicines may be discussed for some people, usually when other options have not helped enough or specialist treatment is being considered. These medicines reduce ovarian hormone activity and can create a temporary low-oestrogen state. Possible side effects can include hot flushes, night sweats, mood changes, sleep problems, headaches, vaginal dryness, reduced libido, low energy and bone density concerns.

GnRH agonists may help symptoms for some people, but they are not a cure for endometriosis and they can have significant side effects. This does not mean they are never the right option, but they should only be started after clear discussion of the potential benefits, risks, side effects, alternatives, expected duration and review plan, so you can make an informed decision.

Sometimes add-back hormone therapy is prescribed to reduce side effects and protect bone health. Before starting, ask why it is being suggested, how long it will be used, how side effects will be monitored, and what the next step will be if symptoms return.

Fertility and pregnancy plans

Hormonal treatments can prevent pregnancy while they are being used, depending on the method. Some may take longer to wear off than others. If you are trying to conceive now, or fertility matters to you in the future, say this before starting treatment. WHO notes that some hormonal methods may not be suitable for people who want to get pregnant. Ask:

  • Will this stop me getting pregnant while I take it?
  • How quickly could fertility return after stopping?
  • Is this suitable if I want to try for pregnancy soon?
  • Should fertility advice or referral be considered?

When treatment should be reviewed

Ask for review if:

  • symptoms are not improving
  • side effects are difficult
  • bleeding becomes heavy or concerning
  • mood changes are significant
  • pain continues to affect daily life
  • symptoms return when treatment stops
  • bowel, bladder, chest, nerve-like or extra-pelvic symptoms are present
  • you feel you are being given medication without a clear plan

Questions to ask

You may want to ask:

  • What is this treatment meant to help with?
  • Does it manage symptoms or remove disease?
  • How long should I try it before review?
  • What side effects should I know about?
  • What side effects need urgent advice?
  • Is this suitable for my health history?
  • How does it affect fertility plans?
  • What happens if symptoms continue?
  • Will investigation or referral continue if symptoms are severe?
  • Are there non-hormonal or surgical options I should understand?

Prepare before you speak with a healthcare professional

Use our Prepare for Appointment Tool to organise your symptoms, previous treatments, side effects, fertility priorities, questions and concerns before your appointment. You do not need a perfect diary. A clear summary of what is happening and how it affects your life can help the conversation feel more focused.

Final reminder

Hormonal treatment can be helpful for some people, but it is not suitable for everyone and it is not a cure. You deserve clear information about what the treatment is expected to do, what its limits are, what side effects to watch for, and what the next step will be if symptoms continue. This resource is here to support your understanding, not replace medical advice from a qualified healthcare professional.