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Hormonal treatment of endometriosis: the oral contraceptive pill HORMONAL TREATMENT OF ENDOMETRIOSIS: THE ORAL CONTRACEPTIVE PILL
The Pill, often known as the oral contraceptive pill or the birth control pill, is not just one drug but rather a group of many drugs first developed for use as a contraceptive in the late 1950s. Initially, they were made up of a combination of synthetic oestrogen and progestogen (synthetic progesterone) but since the 1970s various synthetic progestogen-only drugs have also been used.
The Pill was first used as a treatment for endometriosis in the late 1950s and for many years it was the main form of treatment. It has now been superseded by Danazol and the progestogen-only drugs such as Duphaston and Provera.
Nowadays, many gynaecologists believe that there is no place for the Pill in the treatment of endometriosis because they feel it does not effectively eradicate the condition. However, many gynaecologists believe that it still has a role in the long-term management of endometriosis because they feel that although it does not eradicate the disease it may slow down or halt its progression. Therefore it is sometimes recommended for women with mild or minimal endometriosis in an attempt to stop the progression of their disease.
How the Pill works
It is thought that the Pill works by mimicking the hormonal condition of pregnancy because it leads to high levels of oestrogen and progesterone in the body. The high levels of oestrogen and progesterone suppress ovulation and lead to changes in the endometrial implants which eventually cause them to waste away.
Sometimes the Pill causes an initial enlargement and softening of the endometrial implants and cysts in the first few weeks or months of treatment, which may result in a worsening of symptoms and may occasionally cause endometriomas to rupture.
Dosages of the Pill generally used
There are many different varieties of the Pill available but not all of them are used for endometriosis. Initially, various high dose combinations were used but nowadays most gynaecologists would recommend a combination with a low dose of oestrogen and a relatively high dose of progesterone. The progesterone-only
Mini-Pills are not suitable.
Regardless of the combination used, most gynaecologists recommend that the Pill be taken continuously — every day without a break, for six to twelve months. You will usually be advised to begin with one tablet per day and to increase the dosage by one tablet per day if any vaginal bleeding occurs. The final dosage will usually be the lowest dosage on which you have no vaginal bleeding and this may be three or four tablets per day.
Side effects of the Pill
Side effects when using the Pill for endometriosis are common. Many women experience a greater number of side effects and they are often more severe than those experienced when using the Pill as a contraceptive, because the dosages used for endometriosis are usually much greater.
The more common side effects include vaginal bleeding, fluid retention, abdominal bloating, weight gain, increased appetite, nausea, headaches, breast tenderness, acne, depression, changed libido and vaginal thrush.
You will usually begin to ovulate and menstruate again within four to eight weeks of ceasing treatment and any side effects usually disappear within a few weeks.
How effective is the Pill
As previously mentioned, most gynaecologists these days do not believe that the Pill is an effective treatment for endometriosis. The research suggests that only a small proportion of women obtain relief from their symptoms and that the likelihood of becoming pregnant following treatment is low. In addition, the likelihood of developing a recurrence of the disease soon after treatment is high.
The Pill, pregnancy and breastfeeding
The Pill should not be used during pregnancy as progestogens can cause abnormalities in the developing foetus.
The use of the brands of the Pill containing both synthetic oestrogen and progesterone while breastfeeding is not recommended. The progestogen-only Mini-Pills may be safely used while breastfeeding.
Interaction with other drugs
The Pill interacts with a number of drugs therefore you should tell your gynaecologist if you are taking any other medication.
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Hormonal treatment of endometriosis: the oral contraceptive pill