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Endometriosis

Endometriosis

Surgery: What are the pros and cons of taking hormones too?

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Taking after having surgery for endometriosis can improve the treatment outcomes. But hormonal drugs such as GnRH analogs often have side effects and reduce your ability to get pregnant during treatment.

Endometriosis develops when the kind of tissue that lines the womb starts to grow elsewhere in the abdomen. If these areas of endometriosis tissue (endometrial implants) cause severe pain or affect , some women choose to have surgery. The aim of this surgery is to remove all of the visible endometrial implants.

The idea behind combining surgery with hormone therapy is that it can make the surgery easier and reduce the likelihood of endometriosis symptoms coming back. Hormonal drugs can be taken before and/or after surgery.

Several kinds of drugs can be used for this purpose. They suppress hormone production in the ovaries. One option is GnRH analogs (gonadotropin-releasing ). But these medications have a number of side effects such as increased hair growth, hot flashes and osteoporosis. An alternative to GnRH analogs are hormonal contraceptives like the pill. They usually contain progestins and estrogens, and are generally better tolerated than GnRH analogs.

Good to know:

It is almost impossible for a woman to become pregnant during hormone therapy.

Research on hormone therapy before or after surgery

A group of scientists from the (an international research network) looked into the pros and cons of combining surgery with hormone therapy in the treatment of endometriosis. They evaluated 25 studies in which were used either before or after surgery. A total of about 3,400 women took part in these studies.

The scientists also wanted to find out whether taking both before and after surgery helps. But they couldn't find any research on that.

Research on hormone therapy before surgery

Three studies looked into hormone therapy before surgery. They compared the outcomes of this approach with the outcomes of surgery alone (without hormone therapy). Based on these studies, it's not clear whether taking before the surgery can reduce the size of endometriosis cysts. There is also hardly any data on the effects of this treatment approach on pain or (the ability to get pregnant).

Research on hormone therapy after surgery

22 studies looked into the effects of taking after surgery (over a period of about 3 to 6 months). They suggested that this treatment approach has a positive effect: It reduced the risk of the endometriosis coming back after the treatment. This can also prevent pain over the longer term. It can improve too: Compared to the surgery-only group, more women who had this combined treatment became pregnant afterwards.

Table: Effectiveness of taking after surgery (after about 12 months)
  No hormone therapy Hormone therapy after surgery
In how many women did the pain return? 26 out of 100 18 out of 100
How many women were diagnosed with endometriosis again? 17 out of 100 5 out of 100
How many women got pregnant? 34 out of 100 41 out of 100

Side effects

Taking can lead to hot flashes, sleep problems, a dry vagina and mood swings. But most of the studies didn't look at side effects closely enough to be able to estimate how common they were. Women can't get pregnant during treatment with these .

Chen I, Veth VB, Choudhry AJ et al. Pre- and postsurgical medical therapy for endometriosis surgery. Cochrane Database Syst Rev 2020; (11): CD003678.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Surgery: What are the pros and cons of taking hormones too?

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Updated on March 25, 2025

Next planned update: 2028

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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