Question: My daughter was diagnosed with endometriosis and our only treatment option was birth control pills. Is that right? Are birth control pills really the only way to treat endometriosis?

Larry’s Response: Endometriosis is a serious and painful situation. It is an inflammation outside the uterine cavity, often on the ovaries. The condition is spawned from hormone imbalance, predominantly excess estrogen – the proliferative (growth by the rapid multiplication of cells) hormone.

Estrogen is identified as the hormone that generates the body curves we associate with the woman’s body. Unchecked (unbalanced) proliferation leads to excess weight gain and obesity. In addition, uncontrolled proliferation can irritate and aggravate the areas in the body where it is taking place. Rapidly proliferating endometrial cells cause inflammation and pain.

Untreated endometriosis can lead to infertility.

Somewhere along the line, our medical experts decided that additional estrogen would help. They focused on the use of birth control pills. I’m sure their intentions were sound, but the execution hasn’t been universally successful. When treatment with synthetic hormones fails, the other alternative is surgery.

That’s a sad conclusion and it would not have to be made if the experts would just think a little about the physiology of endometriosis. It is an estrogen dominance situation and it can often be treated by using progesterone. No, not progestins like medroxyprogesterone acetate (MPA). The approach is logical, simple, quick acting, and free of side effects. The intent is to increase progesterone levels to a point where the estrogen activity is balanced and controlled.

I suggest that using real progesterone (bioidentical) is the most rational first approach. The woman may want to use a heavier dose for a few days to bring progesterone levels up quickly – balancing estrogen. Then the standard cycling of bioidentical progesterone can be initiated – usually with success. The cycling of progesterone is consistent with basic physiology (progesterone levels rise and fall in accord with ovulation); 20mg once daily for days 1 through 12, twice daily for days 13 through 26, then stopping until the period starts (the new day one). That’s it.

When viewed through the lens of basic physiology, using birth control pills to achieve balance seems irrational. Treating a failed effort with “the pill” often leads to surgical intervention – an extreme permanent solution to a relatively simple, temporary problem.