How are combination oral contraceptive pills (COCPs) administered for the treatment of endometriosis?

Updated: May 10, 2021
  • Author: G Willy Davila, MD; Chief Editor: Michel E Rivlin, MD  more...
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Answer

COCPs act by ovarian suppression and continuous progestin administration. Initially, a trial of continuous or cyclic COCPs should be administered for 3 months. With pain relief, this treatment is continued for 6-12 months. Pregnancy rates following discontinuation of the pill are 40-50%. This applies to a population unselected for stage and fertility status of the disease. Although few choices are available among individual formulations, note that the long-term efficacy of multiphasic preparations remains unproven.

Continuous noncyclical administration of COCPs, omitting the placebo menstrual tablets, for 3-4 months helps avoid any menstruation and associated pain. A study by Guzick et al examined a head-head-to-head comparison of Lupron and continuous oral contraceptives for the treatment of endometriotic pelvic pain; both were found to be equally effective. [69]

Women with endometriosis are at increased risk of epithelial ovarian cancer, and COCPs are believed to protect against this. [70]


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