Dr. Albee on...
oral contraceptives as a treatment for endometriosis.
When do I use birth control pills for endo?
Controlling disease in some patients
Some stage I and II patients are referred after their diagnosis was made during prior surgery. We may believe that they have persistent disease, but the timing is not good for considering another surgery. If they have few or no symptoms, I may use an oral contraceptive for suppression. I have had a few patients who have been on this form of "control" for several years before they became symptomatic.
Similarly, a patient may have scheduled surgery for three to six months from now. I feel this patient can be suppressed with oral contraceptives until one month before the scheduled procedure.
A teenager who develops symptoms suggestive of endometriosis, but does not have any changes on her physical examination to corroborate the history should be observed for a period of time. If her symptoms are quite significant, OC’s may be a good choice for controlling them.
Residual untreated disease intervals
If we find disease (such as on the bowel) at the time of surgery and are unable to remove it at that time (because a bowel prep was not done, or because the patient’s family or job situation does not permit a bowel resection at this time), the disease may be left untreated for a later time. This again creates the need for interval control and OC’s can be a very good choice.
Which OC’s do I use?
I prefer a monophasic low dose oral contraceptive. I am concerned that sequentials, progesterone only, and triphasics all have more potential to stimulate the ectopic tissue of endometriosis. We are trying to keep the lesions inactive.
Do I prefer cyclic or continuous use?
I have had very good experience with both modes of administration. I would not hesitate to recommend continuous use to any woman who experiences severe menstrual pain during her cycle. With continuous administration, the "sugar" pills are not taken. Instead, the pack is discarded and the new pack started. Most women do not have a period at all when they take OC’s continuously.
What are the advantages of OC’s?
Relatively inexpensive ($20-25 per month)
Very high safety profile with the possible exception of smokers, patients with liver disease, or patients with a previous history of deep vein thrombosis or pulmonary embolism.
Few side effects. Nausea, weight gain, breakthrough bleeding and fluid retention are sometimes reported.
Painful menses frequently improve.
What are the disadvantages?
Menses continue unless used continuously.
Some women have side effects.
In some women the endometriosis will progress.
Estrogen and progesterone continue to circulate in the bloodstream.