How does the visit work?
The doctor reads your answers and sends a plan. Most plans start with ibuprofen or naproxen. These pain pills also lower swelling. Take one with food, only on pain days. Do not take two of them together. You may also take acetaminophen from the store. Follow the package. The doctor may also offer a hormone medicine. The choices are norethindrone acetate, and a birth control pill that you take every day with no break. The label does not list this use. Guidelines do list it for endometriosis pain. You get 13 more weeks of hormone a year than with a usual pack. A small study of this pill saw more blood clots than with usual packs. The label says that study was too small to be sure. On the daily pill with no break, you do not get a regular period. Norethindrone acetate can also stop your period. So a missed period will not warn you that you are pregnant. Watch for tender breasts or an upset stomach. Pain pills do not wait for your paper. For a hormone, the doctor needs to see a paper that says you have endometriosis. If it is missing, the doctor will ask you for it in a message.
Do you diagnose endometriosis?
No. This visit is only for pain from endometriosis that a clinician has already diagnosed. It may have been found by surgery, a scan, or an exam. We do not diagnose it here. If no clinician has diagnosed you, please see your own doctor or a gynecologist.
Do you order tests or scans?
No. We do not order a scan, a blood or urine test, a pregnancy test, or a bone-density scan. We do not do an exam. The doctor relies on the diagnosis you tell us about, on a blood pressure reading you already have, and on your answers.
Why do you ask about pregnancy?
Pain pills and hormone medicines can harm a pregnancy. Endometriosis also raises the chance of a pregnancy outside the uterus. You are sure you are not pregnant only if you have no signs of pregnancy, and at least one of these is true. Your last normal period started in the last 7 days. You have not had sex since your last normal period started. You have used a reliable birth control method the right way every time. A home pregnancy test does not make you sure. We do not order or sell pregnancy tests. If you are not sure, you see a doctor in person today.
Is norethindrone acetate birth control?
No. Norethindrone acetate is the only medicine here that the FDA label names for endometriosis, but it is not birth control. Use condoms if you do not want to get pregnant. This medicine can harm a pregnancy. Do not get pregnant while you take it. It can also stop your period, so a missed period will not warn you that you are pregnant. Watch for tender breasts or an upset stomach.
Why not stronger drugs or opioids?
We do not send opioids or other controlled medicines. Some stronger hormone drugs, such as Orilissa and Myfembree, need bone-density scans or limit how long you can use them because of bone loss. The hormone shot also has a boxed warning for bone loss. We do not order scans, so this visit does not offer them. A gynecologist can talk with you about them.
What if I already take birth control?
This visit starts a hormone. It does not switch or add to one you already use. If you use a hormone now, you can still get ibuprofen or naproxen if they are safe for you. If your pain stays bad after 3 months on a hormone, please see your own doctor or a gynecologist.
Do I pay if no medicine is safe for me?
Some medicines are not safe for some people. The questions check for this. If your answers show that no medicine this visit can offer is safe for you, you get no medicine. We tell you to see your own doctor or a gynecologist. We stop the visit before you pay when we can tell from your answers. If we find this out after you pay, the visit price is usually not refunded.
Which medicines are not safe for me?
Some medicines are not safe for some people. The questions check for this. If one of these fits you, the doctor will not send the medicine it blocks. You can still get a medicine that it does not block. If none is safe for you, you get no medicine. We will tell you to see your own doctor or a gynecologist. Tell us about every allergy and every medicine you take. An allergy to a medicine, or to something in it, blocks that medicine. These block ibuprofen and naproxen. A stomach ulcer, or bleeding from the stomach or bowel, ever. Kidney disease, liver disease, or heart failure. A heart attack, a stroke, a stent, or heart bypass surgery. High blood pressure that is not controlled. A blood thinner, clopidogrel, or a daily anti-inflammatory. Asthma, hives, nose polyps, or another bad reaction to aspirin or a pill like ibuprofen. Age 65 or older. Digoxin, lithium, methotrexate, or cyclosporine. A water pill, or a blood pressure pill that ends in -pril or -sartan. These block both hormones. A blood clot in a leg or lung, a clotting disorder, or a parent, brother, sister, or child with a clot. A heart attack, a stroke or mini-stroke, chest pain from the heart, or a blocked artery. Migraine with aura. Smoking at age 35 or older. Breast cancer, cancer of the uterus lining, or another cancer that hormones can feed. Liver disease, hepatitis, a liver tumor, or yellow skin or eyes in a past pregnancy or with a past pill. A heart valve or heart rhythm problem that raises clot risk. Lupus with positive or unknown antibody tests. Diabetes with complications, or diabetes for more than 20 years. Heart valve disease with complications, high blood pressure in the lungs, or heart failure. Major surgery planned with long bed rest. Long bed rest, or trouble moving around, now after surgery or an injury. Rifampin, rifabutin, a seizure medicine, or St. John's wort. No blood pressure reading from the last 3 months, or a reading of 140/90 or higher. A hormone medicine or device that you already use. These block only the daily birth control pill with estrogen. Medicine for high blood pressure. Weight-loss surgery that shortens the bowel. Gallbladder disease with symptoms now, or treated with medicine. Kidney disease with protein loss in the urine, or dialysis. Sickle cell disease, or an organ transplant that failed. Multiple sclerosis with long bed rest, or active Crohn's disease or ulcerative colitis. Lamotrigine, or a hepatitis C medicine. These block only norethindrone acetate. Any other diabetes, or a cholesterol or triglyceride problem treated with medicine. A BMI of 30 or higher.
What side effects can a hormone cause?
With a hormone, spotting and changes in your period are common. If they bother you, message us. Breast pain, bloating, nausea, and mood changes can also happen. A new headache, or a migraine that is new or worse, is not a normal side effect. See a doctor in person within 7 days if you have a new headache that keeps coming back, does not go away, or is severe while you take a hormone (stop the hormone first). See a doctor in person today if you have a new or worse migraine while you take a hormone. If you take a medicine from us, stop it first. If any warning sign starts, get care as shown in the next answer. Do not wait for our reply.
When do I need care right away?
If more than one of these fits, follow the first one. Call 911 or go to the ER now if you have any of these. If you take a medicine from us, stop it first. You have sudden, severe pain in your pelvis or belly. You faint, or feel too weak or dizzy to stand. You have shoulder pain along with belly or pelvic pain. You have bleeding that soaks a pad or tampon every hour for 2 hours or more. You pass no urine at all. You pass no stool or gas, and your belly is swollen and you vomit. You vomit blood, or your stool is black and tarry. You have chest pain, trouble breathing, or pain or swelling in one leg. You have trouble speaking, weakness or numbness on one side of your body, or a drooping face. You have sudden vision loss, double vision, or a sudden severe headache. You have hives, or swelling of your face, lips, tongue, or throat. Call or text 988, or call 911, if you feel very sad or hopeless, or think about hurting yourself. If you take a hormone, stop it first. Go to the ER or urgent care today if you have a fever of 100.4 F (38 C) or higher, or shaking chills, along with pain in your pelvis, belly, side, or back. Do the same if you have new pain in one side of your back, below the ribs. See a doctor in person today if you have any of these. If you take a medicine from us, stop it first. You are pregnant, you might be pregnant, you have signs of pregnancy, or you are not sure. Do the same for new vaginal discharge that is not normal for you, along with pelvic pain, blood in your stool while you take ibuprofen or naproxen (stop it first), new stomach pain that does not go away, yellow skin or eyes, much less urine than usual, a new skin rash or blisters, or a new or worse migraine while you take a hormone. Pelvic pain during pregnancy needs an exam. See a doctor in person within 7 days if you have new blood in your urine or stool, or new pain when you pass them, or new trouble passing them. Do the same for a new headache that keeps coming back, does not go away, or is severe while you take a hormone (stop the hormone first). Do not wait for our reply.
What if my pain does not get better?
Keep a diary of your pain. It helps your doctor. If your pain is not better after 3 months, or it is different or worse than before, please see your own doctor or a gynecologist. See a gynecologist at least once a year. Keep up your regular breast checks and mammograms with your own clinician.