Although there is no cure for endometriosis, several hormone-balancing treatments are recommended to manage the pain and alleviate symptoms. Endometriosis is different for every patient, meaning treatment options will also vary.
Combined contraceptives containing estrogen and progestin as well as gonadotropin-releasing hormone (GnRH) agonists and antagonists are popular. However, research suggests that taking progesterone for endometriosis can prove successful too.
Read on, for more information on progesterone for endometriosis, as well as some guidance on other therapies that can be practiced in conjunction with hormone-balancing therapy to reduce the pain and other symptoms.
What Is Endometriosis?
Endometriosis is when tissue similar to the endometrial lining of the uterus grows on organs outside the uterus. Most commonly found growing on the ovaries and fallopian tubes, endometrial implants have also been found on the abdomen, bladder, bowel, chest cavity, intestines, and rectum.
Symptoms of endometriosis range from mild to severe, depending on the amount, depth, and location of endometrial implants. Some women, for instance, have mild endometriosis with no symptoms, while others experience chronic pelvic pain, bloating, and cramping that intensifies before and during menstruation.
Fatigue, painful ovulation, pain during sex, heavy menstrual flow, intermittent spotting between periods, and difficulties getting pregnant are also common symptoms of endometriosis.
Estrogen & Progesterone
Because hormone fluctuations can affect the severity and relief of symptoms in women with endometriosis, it helps to understand the roles played by estrogen and progesterone in the body.
In women, estrogen is primarily produced by the ovaries, with smaller amounts produced by the adrenal gland, brain, and fatty tissues. Although it is most commonly known for assisting in reproduction, estrogen also helps to regulate the menstrual cycle and is vital for bone health, brain function, and stabilizing moods.
Progesterone also supports the female body during reproduction by preparing the uterus for pregnancy. It also plays a role in regulating menstruation and contributes to bone strength, libido, weight management, and overall health. Progesterone is also capable of lowering inflammation, calming the nervous system, and improving sleep.
To maintain a regular menstrual cycle, a healthy reproductive system, and optimal overall health, estrogen and progesterone levels rise and fall at various times during the month and during each day.
How Do Estrogen and Progesterone Affect Endometriosis?
When trying to comprehend the effect that hormones can have on endometriosis, understanding the natural fluctuations of estrogen and progesterone is key. Normally, they are synchronized in a regulated way to maintain the natural flow of the menstrual cycle and support the body through pregnancy if implantation occurs.
For many women with endometriosis, however, the automatically synchronized signals between estrogen and progesterone are believed to be disordered. This often results in estrogen dominance and progesterone resistance.
Given that estrogen is known to thicken the endometrium (uterus lining) in preparation for the implantation of a fertilized egg, scientists believe that estrogen surges during the menstrual cycle also thicken the endometrial implants outside the uterus.
This swelling, breakdown, and eventual bleeding of endometrial tissue (menstruation) is believed to contribute to the intensified pain felt before and during a period for patients with endometriosis.
According to research, estrogen surges will typically intensify endometriosis symptoms, and falls in progesterone levels will typically relieve the intensity of symptoms. The severity of endometriosis symptoms is therefore thought to directly correlate with the rise and fall of estrogen and progesterone.
It is for this reason that combined contraceptives containing estrogen and progestin (a synthetic form or progesterone) are typically the first line of treatment prescribed to women with endometriosis. Taken as a pill, patch, ring, or IUD, combined contraceptives tend to regulate the menstrual cycle, or prevent it, to minimize the severity of endometriosis symptoms.
Given that symptoms of endometriosis can feel different for each patient, however, the combined contraceptive hormone therapy is not successful in relieving symptoms for everyone. For some, the increase in estrogen levels could worsen endometriosis symptoms. Increasing estrogen levels also heightens the risk of breast cancer and uterine cancer in some women.
How Progesterone Helps Endometriosis
If women with endometriosis cannot take estrogen due to a familial history of breast cancer, cardiovascular disease, or a higher risk of blood clots, then progestin-only hormone therapy is recommended. It might also be recommended for women with endometriosis who are found to be estrogen-dominant and progesterone-resistant.
When taken daily and continuously over the long term, progestins, which are synthetic versions of progesterone, are known to thin the uterus lining and lighten or prevent regular menstruation, thereby reducing the severity of endometriosis symptoms.
Continuous progestin hormone therapy is also known to thin endometrial implants outside the uterus, and reduce the frequency of spotting or breakthrough bleeding that is often experienced with combined contraceptive hormone therapy.
For effective results, and to reduce the chance of spotting, it is recommended that continuous progestin hormone therapy for endometriosis should be taken at the same time each day.
It is also important to note that high doses of progestin are required to reduce estrogen levels and lighten or prevent menstruation. Because reduced estrogen levels can cause loss of bone density, high doses of calcium and vitamin D are typically taken in conjunction. Regular exercise and a stable weight are also advised to prevent loss of bone density.
Progestin vs Natural Progesterone: What’s The Difference?
Progestin is a synthetic progesterone produced in a lab and is available in pill form, as an IUD, or injection. Continuous progestin hormone therapy is considered safe and effective for most women with endometriosis. Although bloating, depression, and weight gain have been reported by a small percentage of women, it is well accepted by the majority.
Natural progesterone, known as bioidentical progesterone, is made from plant fats and natural oils, and is available in capsule form, as well as vaginal gel and suppositories. Although some holistic healthcare practitioners recommend bioidentical progesterone above progestins, using it to treat endometriosis is not widespread in America.
This is primarily due to the small amount of research carried out on its efficacy when compared to the long-term clinical trials carried out on synthetic progestin.
Which is Better for Endometriosis: Progestin or Progesterone?
To determine if continuous progestin or natural progesterone therapy is better for you, it’s best to speak with your healthcare provider about the benefits, risks, and possible side effects for your particular situation.
Holistic experts who frequently use natural progesterone to treat endometriosis maintain that it provides more anti-inflammatory relief, has fewer side effects, and is more adaptable in its dosage levels than progestin. Some small studies have also linked natural progesterone with a lower risk of cardiovascular disease and breast cancer compared to synthetic progestins.
Natural progesterone is also known to initiate new bone formation, meaning that when high doses of vitamin C and vitamin D are taken in conjunction with continuous progesterone therapy, loss of bone density is not as high of a risk as it is with progestin and other hormone-balancing therapies.
Helpful Natural Therapies for Endometriosis
Whether your healthcare provider recommends combined contraceptives, GnRH agonists/antagonists, or continuous progesterone therapy to treat endometriosis, the following natural therapies, when used in conjunction, are incredibly helpful.
Pelvic Health Physical Therapy
Physical therapists who specialize in pelvic health not only understand how to relieve pain within the muscular structure of the pelvic cavity, but they also teach patients with endometriosis how to ease their symptoms at home with self-massage and stretching.
One of the medical tools recommended by pelvic health physical therapists is an ergonomic medical device called a pelvic trigger point wand. Used to relieve chronic pelvic pain, pelvic wands can massage deep trigger points in the pelvis and soften the scar tissue around endometriosis implants. These Temperature Therapy Pelvic Wands from Intimate Rose also provide soothing hot and cold therapy for added relief.
Normally sold in sets of incrementally increasing sizes, vaginal dilators are used to relax tight vaginal muscles, relieve painful sex, and reduce the fear of penetration, all of which are symptoms often associated with endometriosis. These firm yet pliable tube-shaped devices made from body-safe, medical-grade silicone are also widely recommended by pelvic health physical therapists. See our guide on using dilators for endometriosis.
Before purchasing pelvic wands and/or vaginal dilators to treat endometriosis, consider scheduling an appointment with a pelvic health physical therapist or OB/GYN who can show you how to use each correctly for the most effective results.
Depending on the severity of symptoms, hormone therapy to regulate the menstrual cycle can provide relief from endometriosis. The most common forms of hormone therapy prescribed to ease symptoms of endometriosis include combined contraceptive therapy and continuous progestin hormone therapy.
Although both can reduce symptoms of endometriosis, the possible side effects should be discussed with your healthcare practitioner before use.
For additional relief from endometriosis, or instead of hormone therapy, pelvic health physical therapists recommend using pelvic wands and vaginal dilators to massage painful trigger points and relieve chronic pelvic pain.
National Library of Medicine - Progesterone and Estrogen Signaling in the Endometrium: What Goes Wrong in Endometriosis? - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695957/
Clue - The Menstrual Cycle - https://helloclue.com/articles/cycle-a-z/the-menstrual-cycle-more-than-just-the-period
Brigham and Women’s Hospital - Medical Treatments for Endometriosis - https://www.brighamandwomens.org/obgyn/infertility-reproductive-surgery/endometriosis/medical-treatment-for-endometriosis
Science Direct - Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills - https://www.sciencedirect.com/science/article/pii/S0015028217300377
Centre for Menstrual Cycle and Ovulation Research – Endometriosis and Natural Progesterone - https://www.cemcor.ubc.ca/ask/endometriosis-and-natural-progesterone
Cochrane – Hormonal Contraceptives and Bone Health In Women - https://www.cochrane.org/CD006033/FERTILREG_hormonal-contraceptives-and-bone-health-in-women
National Library of Medicine - Physiotherapy Management in Endometriosis - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740037/
Middlesex MD – Dilators for Endometriosis - https://middlesexmd.com/blogs/pelvic-health/dilators-for-endometriosis
National Library of Medicine - Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8779548/