Advanced stage endometriosis with an endometrioma is very difficult to treat in the long term because of how rapidly these cysts normally reoccur. Extended treatment with Lupron or letrozole can have significant side effects, including bone loss. Birth control pills have been advocated to help slow the growth of endometriosis, but many physicians wonder how they should be given, in a cyclic or continuous dose. The question also arises about whether birth control pill treatment prolongs the endometrioma free interval and reduces the need for surgery. A recent randomized controlled study starts to address these issues. In summary, the study compared three groups of women: no birth controls pills, cyclic birth control pills, and continuous birth control pills. Ultrasounds were used to measure endometrioma recurrence, the size of the recurrent endometriomas, and the growth rate during at least two years of follow up.

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This study found that the recurrence rate was two to three times higher in the women who did not take birth control pills. As well, the size of the recurrent endometriomas was significantly larger in women not on birth control pills, and the endometriomas grew at a significantly higher rate in those who did not take the birth control pills. When comparing cyclic to continuous birth control pills use, a tendency occurred in every category for the continuous birth control pills to be more advantageous, but this difference was not statistically significant.

Based on these results and others, the use of continuous birth control pills following surgery is the recommended course of action. Another good option is surgery combined with four to six months of Lupron, then continuous birth control pills. These options will prolong the disease free interval, decrease the need for surgery, and reduce the symptoms. Obviously, these treatment recommendations are only possible for women not wanting to conceive in the immediate future.

If you have any questions concerning endometriomas or if you have any topics that you would like to see in our newsletter, feel free to call our office or visit our website at www.ivfplano.com.