I am 33 and have dealt with endometriosis for years. Any type of hormone therapy, including birth control, causes severe side effects. I have noticed that a lot of women with severe endometriosis cannot tolerate hormones. Is there a connection?

E.W.

Endometriosis is a chronic condition that is best managed by a combination of surgical, hormonal and nutritional therapies. This means that the inability to tolerate various hormonal manipulations may hamper successful control of your symptoms. There is no inherent reason why women with endometriosis should not tolerate hormonal therapy if used appropriately. Unfortunately, the use of commonly available synthetic hormones may be associated with various side effects.

I have noticed that many of my patients do best when we use a GnRH-agonist to suppress their own hormone production and then begin low doses of natural estrogen and progesterone hormone replacement. While these natural hormones can be taken orally, most of the administered drug is destroyed in the stomach. I prefer to utilize a troche, which combines both the estrogen and the progesterone in a small candy-like tablet that dissolves in the cheek.