- Hormones suppress, they do not cure.
- Two failed options is a trigger for surgical review.
- GnRH is a bridge, not a plan.
The four main options
Combined oral contraceptive pill: continuous use suppresses periods and reduces pain in mild disease. Progestogens (dienogest, norethisterone): more targeted, effective for pain in moderate disease. Mirena IUS: excellent for adenomyosis-linked pain and heavy periods. GnRH analogues: temporary medical menopause for severe disease — usually a bridge, not a long-term plan.
When hormones stop being enough
If pain persists despite two well-tried hormonal options, or if fertility is a priority, surgery — specifically excision — is the next step. Continuing to trial hormones indefinitely delays diagnosis and worsens disease.
Frequently asked questions
Do hormones make endometriosis smaller?
They suppress activity but rarely shrink established deep lesions.
Can I get pregnant on GnRH?
No — it induces temporary menopause. Fertility returns after stopping.
Is dienogest better than the pill?
For moderate disease, usually yes — but with progestogen side effects.
Could a doctor-led plan help you?
A 30-minute video consultation with Dr Berra Önsoy — reviewing your symptoms and imaging and giving you a clear personalised plan for endometriosis surgery.
Request a video consultation