Here’s why you still have endo symptoms on hormonal birth control

If you’ve been diagnosed with endometriosis, or even if you just suspect you have it, chances are the first thing you were offered was hormonal birth control or a hormone-suppressing drug like Lupron.

For some women, these medications can bring relief. But for so many others, they either stop working or come with side effects that make you feel worse in the long run. The bigger issue is that these medications are not enough to manage endometriosis. They don’t fix what’s actually driving it.

Let’s start with the basics.

What Endometriosis Actually Is

Endometriosis is a disease where tissue similar to the lining of the uterus grows outside the uterus, often in the pelvic cavity and even beyond it. Endo has been found on almost every organ in the body, and it can deeply affect your quality of life. It doesn’t just cause painful periods. It can cause severe fatigue, chronic digestive issues, pain with bowel movements, bladder pain, back pain, bloating, and an overall sense that your body is working against you.

When most women go to their doctor looking for help, they’re told that birth control will “balance hormones,” “regulate cycles,” or “stop endo from growing.” But endometriosis isn’t a hormone problem. It’s a chronic, inflammatory condition that impacts multiple systems in your body.

You cannot fix a full-body inflammatory disease by shutting down one single system.

Why Hormonal Birth Control Is a Band-Aid

Hormonal birth control and drugs like Lupron work by cutting off communication between your brain and your ovaries. When that connection is disrupted, you stop ovulating, which also means you stop making your body’s natural estrogen and progesterone.

This can temporarily lower estrogen levels and sometimes ease pain, but these synthetic hormones don’t have the same benefits as the real thing. Progestins, for example, don’t have the same calming or mood-supporting effects that progesterone does. And over time, that can show up as anxiety, sleep issues, or even worsening mood symptoms.

If you’re on a progestin-only birth control, you’re still likely in a state of estrogen dominance. That’s not ideal for anyone, but especially not for someone with endometriosis. Remember, this disease makes its own estrogen tooo.

Now, some women with an IUD do still ovulate naturally, which is amazing because it means you can still make your own hormones but that’s not always true for everyone, especially in the first few years of having one.

So yes, if hormonal birth control helps you function and keeps your pain manageable, I support that fully. But it’s important to know that it isn’t treating the root cause. It’s managing symptoms.

Why Endometriosis Needs a Full-Body Approach

Endometriosis isn’t just happening in your uterus. It involves your immune system, gut, liver, nervous system, and even how your body manages stress. That’s why it’s so important to look at all these pieces together.

Here are a few of the main systems I focus on when I work with my endo clients:

1. Blood Sugar

This is one of the most overlooked pieces of endo management. If you’re skipping meals, under-eating or not eating enough balanced foods throughout the day, your body has to work overtime to make fuel. That puts stress on your liver, raises cortisol, and can increase estrogen while lowering progesterone.

When blood sugar is unstable, inflammation increases, your hormones become more erratic, and symptoms like fatigue, anxiety, and pain flare up. Eating enough and eating balanced meals is one of the simplest and most effective ways to calm inflammation and help your hormones.

2. Detoxification

Your liver is responsible for breaking down estrogen and detoxifying your body from medications, alcohol, and environmental toxins. If your liver is overloaded and doesn’t have the nutrients it needs to do its job, estrogen and other toxins can build up. That buildup can fuel inflammation and worsen pain. Also under -eating can put your liver in a place where it’s making glucose aka fuel for your body all day and this taxes the liver.

And if your bowels aren’t moving regularly, this adds further burden to your liver as it has to refilter back through old hormones and toxins on top of new ones.

3. Digestion

Your gut plays a major role in endo symptoms. Constipation, bloating, nausea, or diarrhea aren’t just “normal period things.” They’re signs that your digestive system is struggling.

When you’re not having regular bowel movements, your body can’t properly eliminate estrogen and toxins. These substances get recycled into the bloodstream and can lead to even more estrogen dominance and inflammation.

Many women with endo also have imbalances in their gut microbiome, low stomach acid, or poor absorption. This makes it harder for your body to get the nutrients it needs to reduce inflammation, calm your immune system and heal. This is why I love running GI map stool testing with my clients because I get to dig deeper into their gut health and microbiome to see if there are areas we can better support to improve symptoms.

4. Nervous System Regulation

Almost every woman I work with who has endo is living in fight or flight. Constantly on edge, pushing through pain, running on fumes, and feeling like rest is something they have to earn. Over time, that constant stress response affects your digestion, increases inflammation, and tightens the pelvic floor, which makes pain worse.

When your body is constantly in survival mode, it cannot heal. Supporting your nervous system isn’t “woo-woo”... it’s foundational for managing a disease like endo.

5. Minerals and Nutrients

Endo women are often depleted. Low levels of magnesium, zinc, vitamin D, sodium, potassium, and copper imbalances can all worsen inflammation, pain, and fatigue.

To make things worse, birth control depletes many of these nutrients even further and can actually increase systemic copper (a nightmare for endo). That’s why women often start feeling even more exhausted or anxious the longer they’re on it.

Replenishing minerals through food and targeted supplements can make a huge difference in your energy, mood, and pain levels. This is why I love running the HTMA (hair tissue mineral analysis) because it allows us to look at your mineral patterns and how we can support those to improve symptoms like period pain, blood sugar imbalances, PMS, etc.

Why Surgery Alone Isn’t the Full Answer

Before anyone jumps down my throat, I am not saying excision surgery doesn’t work. It can absolutely be life-changing for many women. But when you’ve had three or four excision surgeries and the pain keeps coming back, it’s time to start asking why.

Surgery removes lesions, but it doesn’t stop the inflammation or immune dysfunction that allowed them to grow in the first place. You still have to address the underlying systems that are driving the disease.

Otherwise, it’s like amputating a diabetic foot without addressing the blood sugar issues that caused it. You’re removing a symptom, not addressing the cause.

The Bottom Line

You deserve more than quick fixes and surface-level solutions. Managing endo takes a full-body approach that looks at your hormones, gut, liver, nervous system, minerals, and stress.

That’s exactly what I help my clients do in my one-on-one coaching. We dig deeper to uncover what’s actually driving your pain, fatigue, and inflammation so you can finally start feeling like yourself again.

If you’re planning for excision surgery, be sure to grab my free Pre and Post-Op Endo Surgery Checklist. It walks you through how to support your body before and after surgery so you can recover well and reduce flare-ups.

And if you’re ready to go deeper and start addressing the root causes of your symptoms, DM me on IG and let’s chat! I’d love to connect and help you get out of survival mode!

Another great way to stay connected if you’re not ready for all that is by tuning into the Radiate with Rita Podcast + my weekly Radiate + Thrive newsletter where I drop tips about managing endo + chronic illness, how I navigate my own journey, recipes + all the things to make your journey a little easier! Subscribe to Radiate + Thrive here!