Endometriosis - Lifestyle Changes

(Page 2)

Standard OCs are the first-line treatment. They come in a 28-pill pack that contains 21 active pills and 7 inactive pills. Women with severe pain who have not been helped by standard combination OCs may benefit from switching to newer continuous-dosing combination OCs. Continuous-dosing oral contraceptives aim to reduce -- or even eliminate -- monthly periods and thereby prevent the pain and discomfort that often accompanies menstruation. These OCs contain a combination of estradiol and the progestin levonorgestrel but use extending dosing of active pills.

OCs with continuous dosing include:

• Seasonale, contains 81 days of active pills followed by 7 days of inactive pills. Women have on average a period every 3 months.
• Seasonique produces about 4 periods a year. A woman takes 84 days of levonorgestrol-estradiol pills followed by 7 days of pills that contain only low-dose estradiol.
• Lybrel, supplies a daily low dose of levonorgestrel and estradiol with no inactive pills. Because it contains only active pills, which are taken 365 days a year, it completely eliminates monthly menstrual periods. Over 50% of women in clinical trials completely stopped menstrual periods by the end of the first year. Some women, however, had occasional unscheduled bleeding or spotting during the first 3 - 6 months.

---

---

Estrogen and progestin each cause different side effects. The most serious side effects are due to the estrogen in the combined pill. Uncommon but more dangerous complications of OCs include high blood pressure and deep-vein blood clots (thrombosis), which may contribute to heart attack or stroke.

[For more information, see In-Depth Report #91: Birth control options for women.]

Progestins

Progestin alone may be helpful for women whose pain has not been relieved with combination estrogen-progestin oral contraceptives. Progestins can prevent ovulation and reduce the risk for endometriosis in the following ways:

• They block luteinizing hormone (LH), one of the reproductive hormones important in ovulation.
• They change the lining of the uterus and eventually cause it to atrophy.
• They may provide pain relief equivalent to the more powerful hormone drugs. Some doctors recommend them as the first choice for women with endometriosis who do not want to become pregnant.