Continuous Combined Hormone Therapy May Control Endometriosis Pain

Laurie Barclay, MD

September 19, 2003

Sept. 19, 2003 -- Continuous combined hormone therapy may be appropriate for women with endometriosis pain not controlled by cyclic therapy, according to the results of a prospective, self-controlled trial published in the September issue of Fertility & Sterility.

"Delaying menses by extending the duration of [oral contraceptive (OC)] pill use is generally an effective and well-tolerated modality for relief of menstruation-related symptoms in women using OCs cyclically," write Paolo Vercellini, MD, from the University of Milan in Italy, and colleagues. "Long-term continuous OC use can be proposed to women with symptomatic endometriosis and menstruation-related pain symptoms."

At a tertiary care and referral center for patients with endometriosis, 50 women who underwent surgery for endometriosis in the previous year and had recurrent dysmenorrhea despite cyclic OC use were treated for two years with continuous use of an OC containing ethinyl estradiol (0.02 mg) and desogestrel (0.15 mg).

During the study period, 19 women (38%) reported amenorrhea, 18 women (36%) reported spotting, and 13 women (26%) reported breakthrough bleeding. The mean number of bleeding episodes lasting more than seven days, leading to suspension of OC for seven days, was 5.5 ± 2.1.

At two-year follow-up, dysmenorrhea improved on a visual analog scale (from 75 ± 13 at baseline to 31 ± 17) and on a verbal rating scale (from 2.4 ± 0.5 to 0.7 ± 0.6). Seven women (14%) reported moderate or severe adverse effects. At final evaluation, 13 women (26%) were very satisfied with therapy, 27 (54%) were satisfied, one (2%) was uncertain, eight (16%) were dissatisfied, and one woman (2%) was very dissatisfied.

"Continuous use of an OC can be considered an effective, nonsurgical treatment alternative in women with symptomatic endometriosis and menstruation-related pain symptoms who do not want children," the authors write. "This regimen combines relief of pain, prevention of estrogen deprivation effects, good tolerability, possibility of immediate suspension, contraception, low costs, and, most important, possibility of prolonging therapy indefinitely. Finally, monophasic OCs have recently been demonstrated to down-regulate cell proliferation and enhance apoptosis in the endometrium of patients with endometriosis."

Fertil Steril. 2003;80:560-563

Reviewed by Gary D. Vogin, MD

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