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The combined
oral contraceptive pill for endometriosis
by Ros Wood
The combined oral contraceptive pill has been used
for women with endometriosis since the late 1950s,
and for many years it was the main hormonal drug used
[1].
The combined oral contraceptive pill is not just one
drug. Rather, there are many different types, each
of which contains a specific low-dose combination
of synthetic oestrogen and progestagen (progesterone).
The main advantages of the pill are that it is inexpensive
and is usually reasonably well tolerated by women
[2]. It can also be taken safely for many years if
necessary, unlike most of the other hormonal drug
treatments for endometriosis [2].
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| HOW
IT WORKS |
|
Like all the other hormonal treatments, the pill does
not cure endometriosis. Rather, it alleviates the pain
of endometriosis by suppressing menstruation and inhibiting
the growth of the endometrial implants.
Because everyone responds differently
to different dosages of hormones, it is some times necessary
to "experiment" until one finds the pill that
works best, and has the least side effects.
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| DOSAGE
|
Depending on your symptoms, some gynaecologists recommend
that the pill be taken daily for blocks of 3 Weeks,
followed by a break of 1 week, during which time you
will have a light period. This is the way the pill is
taken when used as a contraceptive.
However, with endometriosis-associated pain, some gynaecologists
recommend that the pill be taken daily continuously;
or daily for blocks of 3–4 months, followed by
a break of 1 week, during which time you will have a
light period.
Taken in any of these ways, you can safely use the pill
for many years [2].
Theoretically, taking the pill continuously or for blocks
of 3–4 months should be more effective in suppressing
endometriosis than taking it for blocks of 3 weeks,
because it results in fewer menstrual periods. However,
little research has been done to support this hunch.
In one study involving women whose symptoms had not
been alleviated with cyclic (3 week blocks) use of the
oral contraceptive pill, 80% of the women were satisfied
or very satisfied with the results of taking the pill
continuously [3].
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| EFFECTIVENESS
FOR PAIN SYMPTOMS |
Very few studies have looked at the effectiveness of
the combined oral contraceptive pill in treating the
pain-related symptoms of endometriosis. Nevertheless,
the existing evidence suggests that its effectiveness
in alleviating pain is similar to the other hormonal
drugs during treatment, and there is no difference 6
months after stopping taking the pill [2].
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| EFFECTIVENESS
FOR INFERTILITY |
The combined oral contraceptive pill — like all
the hormonal treatments used for endometriosis —
will not improve your chance of conceiving, so it should
not be used as a treatment for infertility [4].
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| KEEPING
TRACK |
You should visit your gynaecologist about 6–8
weeks after starting the pill to discuss how the treatment
is progressing, and after that every 6 - 8 monts. However,
do not hesitate to contact your gynaecologist if you
develop any problems between scheduled visits.
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| PREGNANCY
AND BREASTFEEDING |
|
There is no conclusive evidence to suggest that taking
the pill during pregnancy will endanger the developing
foetus. However, you should not to take the pill if
there is any possibility that you may be pregnant [5].
Small amounts of the hormones that make up the pill
can be passed into breast milk. Therefore, you should
not use the pill while breastfeeding [5].
The pill interacts with some medicines, so do tell your
gynaecologist if you are taking any other medicines
or supplements, including any you have bought from a
pharmacy, health food shop or a supermarket.
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| SIDE
EFFECTS |
You may experience some side effects when using the pill.
The more common ones include irregular vaginal bleeding,
fluid retention, abdominal bloating, weight gain, increased
appetite, nausea, headaches, breast tenderness and depression.
Nausea and breast tenderness usually settle after 1–2
months of treatment. The remaining side effects usually
disappear within a few weeks after you stop taking the
pill, and you will usually start ovulating and menstruating
again within 4–6 weeks of taking the last tablet.
|
| REFERENCES |
1. Kistner RW. Conservative management of endometriosis.
Lancet 1959;79(5):179-83
2. Kennedy S. The Patient's Essential Guide to Endometriosis.
England: Alden Press, 2004: 54.
3. Vercellini P, Frontino G, De Giorgi O et al. Continuous
use of an oral contraceptive for endometriosis-associated
recurrent dysmenorrhea that does not respond to a
cyclic pill regimen. Fertil Steril. 2003;80(3):560-3.
4. Kennedy S, Bergqvist A, Chapron C, D'Hooghe T,
Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan
E. ESHRE guideline for the diagnosis and management
of endometriosis. Human Reprod 2005;20(10):2698-2704.
5. Royal Women’s Hospital’s Drugs in Pregnancy
and Breastfeeding Handbook.
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| ACKNOWLEDGMENTS |
Thank you to the following for reviewing this article
prior to its publication:
Andrew Prentice, Senior Lecturer and Consultant Gynaecologist,
Cambridge University, United Kingdom
Paolo Vercellini, Associate Professor, University of
Milano, Italy
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| SEE
ALSO |
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