Oral contraceptive pills (OCP) are widely used as first-line treatment for painful symptoms associated with endometriosis and they are also used for maintenance treatment following GnRH agonist therapy. However, as previously stressed, it is evident that the medical treatments currently available do not cure endometriosis, independently of the hormonal milieu induced and the presence of amenorrhea. Ectopic endometrial implants survive, although in atrophic form, ready for reactivation when suspension of the treatment occurs. A more rationale therapeutic objective might be simple limitation of the growth of eutopic and ectopic endometrium; hypomenorrhea obtained with OCP containing a prevalent progestogen component and low estrogen doses, could reduce the amount of retrograde menstruation and endometrial synthesis of prostaglandins, with decreased myometrial contractility and pelvic pain. This could give patients with endometriosis an acceptable quality of life. However, the relationship between early OCP use and risk of endometriosis as well as specific disease outcomes remains to be determined.