Hormonal Therapy
Relief without Cure
The State of Modern Treatment
Hormonal Therapy Helps—But Doesn’t Heal
Today’s mainstream medical therapy for endometriosis is based largely on hormones such as birth control pills, progestins, or medications that lower estrogen. These approaches can ease pain and reduce bleeding, but they generally suppress symptoms rather than treat the disease itself. Emerging new therapies in clinical trials or laboratories around the world are focused more on immunomodulation and other targeted molecular options, and are going to be more therapeutic. But for now, treatment is surgical and hormonal.
Confirm Before You Treat
Why Diagnosis First Matters
Some guidelines suggest that hormonal therapy should be tried first when a diagnosis of endo is suspected. The suspicion is based on your symptoms, sometimes on a physical examination and imaging like ultrasound or MRI. But endometriosis can only be confirmed through surgical biopsy, usually obtained during careful excision surgery. Without this, prescribing hormones is essentially guessing. At Lotus our position is that hormonal suppression without diagnosis may mask disease activity, delay definitive treatment, allow progressive fibrosis and damage to organs, and expose patients to side effects without ever proving what’s really going on.
When Biology Stops Responding
The Problem of Hormone Resistance
Many endometriosis lesions show changes in their hormone receptors, and these changes can also change over time. In particular, progesterone receptors often become less sensitive or “resistant” to hormonal therapy. This means that even when patients take progestins or birth control pills, the diseased tissue does not respond in the same way as normal endometrium. As a result, pain relief is often incomplete and the disease may continue to progress quietly. As a sidebar note, adenomyosis seems to respond better to hormones than endometriosis and this is further discussed in our section on adenomyosis.
A Partial Solution
Orlissa (Elagolix)
Orlissa is an oral medication that lowers estrogen levels in a dose-dependent way, creating a kind of “partial menopause.” For some, this reduces pain. But it comes with important caveats:
Relief is often modest and temporary — symptoms tend to return once the medication is stopped.
Side effects can be serious: bone thinning, hot flashes, mood changes, and cardiovascular risks.
Because of these risks, Orlissa is only approved for short-term use.
In other words, it helps some patients for a relatively short period of time, but it does not address the root biology of endometriosis, since hormones are not the only drivers of endo or adenomyosis. Given the risks, it may be prudent to have a clear diagnosis before prescribing agents like this.
Hormonal Therapy Falls Short
Why Deep Estrogen Suppression Fails Long-Term
Medications that dramatically lower estrogen — including Orlissa, GnRH agonists, or even surgical menopause — cannot be used long-term without harm. Estrogen is vital for bone health, heart protection, and brain function. Cutting it too low causes early osteoporosis, increases cardiovascular risks, and affects mood and memory. These drugs lower the “fuel” for endometriosis, but they do not correct the inflammation, nerve growth, and immune dysfunction that also drive the disease. These drivers, on a genetic and molecular basis, are likely different in each person.
Many Paths, One Goal
A Spectrum of Options
At Lotus, we view endometriosis care as a spectrum because endo seems to be multifactorial and polygenetic, which means it is likely not the same disease for everyone. In most cases, after surgical confirmation and cornerstone excisional treatment, there are multiple post-operative therapies that we explore to maximize your healing and maintain relief.
Lifestyle Approaches
Nutrition, stress reduction, and minimizing exposure to excess environmental estrogens can help regulate inflammation, improve hormonal harmony, and reduce symptom flare-ups alongside medical or surgical treatment.
Natural Progesterone vs Synthetic Progestins
Some evidence suggests that micronized (bioidentical) progesterone may work more effectively with the body’s hormone receptors than synthetic progestins, which often come with side effects from unwanted androgen or steroid activity. This gentler approach may better support balance without as many systemic effects.
Conventional Hormone Suppression
While not curative on its own, this approach can be valuable as a post-operative maintenance strategy—helping to stabilize hormone levels, lessen inflammation, and lower the chance of symptom recurrence.
Orlissa or GnRH agonists
These short term options are typically reserved for carefully selected cases, such as preparing for fertility treatments under the guidance of a reproductive endocrinologist (REI), but they do have their uses and are utilized when appropriate.
Guided by Research, Led by Experience
References
Progesterone Receptor Ligands for the Treatment of Endometriosis: The Mechanisms Behind Therapeutic Success and Failure
Reis, F. M., Coutinho, L. M., Vannuccini, S., Batteux, F., Chapron, C., & Petraglia, F.
Human Reproduction Update, 26(4), 565–585 (2020).Progesterone Resistance in Endometriosis: Origins, Consequences, and Interventions
Patel, B. G., Rudnicki, M., Yu, J., Shu, Y., & Taylor, R. N.
Acta Obstetricia et Gynecologica Scandinavica (AOGS), 96(6), 623–632 (2017).Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists — A Review
Donnez, J., & Dolmans, M.-M.
Journal of Clinical Medicine, 10(5), 1085 (2021).Clinical Pharmacology of Elagolix: An Oral Gonadotropin-Releasing Hormone Receptor Antagonist for Endometriosis
Shebley, M., Polepally, A. R., Nader, A., Ng, J. W., Winzenborg, I., Klein, C. E., Noertersheuser, P., Gibbs, M. A., & Mostafa, N. M.
Clinical Pharmacokinetics, 59, 297–309 (2020).Hormonal Treatments for Endometriosis: The Endocrine Background
Vannuccini, S., Clemenza, S., Rossi, M., et al.
Reviews in Endocrine and Metabolic Disorders, 23, 333–355 (2022).
Beyond Hormones and Suppression
The Path to True, Lasting Relief
While hormonal therapy can temporarily quiet symptoms, true long-term solutions come from addressing endometriosis at its root. That begins with accurate diagnosis and, when appropriate, expert excision surgery to physically remove disease tissue. Emerging molecular diagnostics and targeted therapeutics are on the horizon, but today, surgical precision remains the cornerstone of care—supported by integrative medicine that blends the best of mainstream and holistic approaches.
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