Hormonal Therapy

Relief without Cure

Understand how hormonal therapy fits into endometriosis care — easing symptoms for many, yet falling short of addressing the root cause of the disease. Speak with us to learn about all your options.

Close-up of woman injecting a hormonal therapy shot in shoulder with injection pen

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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, natural progesterone, 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. Choosing the hormone and when to sparingly use it is critically important!

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.

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When Biology Stops Responding

The Problem of Hormone Resistance

Many endometriosis cells show changes in their hormone receptors, which are like tiny molecular locks that hormones, which are like keys, plug into. These abnormal receptors 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 progesterone, progestins or birth control pills, the diseased tissue does not respond in the same way as normal endometrium, which contains normal receptors. 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.

Closeup shot of a younger white female giving herself a hormone injection in the side of her abdomen

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” but with less side effects than other GnRH analogs. For some, this reduces pain. But it comes with important warnings:

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, liver damage, 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 some progestin therapies — 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.

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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

As a prudent baseline, proactive attention to nutrition, stress reduction, and minimizing exposure to excess environmental estrogens can help. These all regulate inflammation, improve hormonal harmony, and reduce symptom flare-ups alongside medical or surgical treatment.

Learn About Integrative Medicine

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 recurrence from microscopic residual or new endo lesion growth.

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. The risk vs benefit for very short courses of treatment are highly individual.

Guided by Research, Led by Experience

References

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, if discovered, expert excision surgery to physically remove diseased 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.