I've heard that birth control pills can clear up endometriosis. Is this true? How long would it take to clear up a case of moderate-to-severe endometriosis? M.G.
One should not look at any therapy as a "cure" for endometriosis. A more realistic goal is to focus on the symptoms and how they can be controlled or eliminated. Like diabetes and high blood pressure, endometriosis is a chronic disease. The disease has a genetic and an immunologic component. Until our therapy can address an individual's genetic makeup or address specific immune abnormalities that are seen with endometriosis, we achieve the best results by listening to the patient's symptoms and offering various treatment options that may directly address those complaints.
Traditional treatment has often involved surgery, hormonal manipulation, or both. Hormonal therapy that attempts to mimic either menopause or pregnancy can often provide relief of symptoms. For instance, drugs like danazol (Danocrine) and GnRH-agonists (leuprolide, nafarelin, goserelin) work by creating a low- estrogen menopause-like environment in which the endometriosis becomes dormant. Similarly, administration of continuous estrogen and progesterone with birth control pills to mimic pregnancy may relieve symptoms. This seems to be quite effective for many women. Once you begin after therapy with continuous birth control pills, there is often a period of time during which the pain may intensify. Many women also find they are unable to tolerate continuous use of the pill due to headache, depression, bloating or breast tenderness. For those who do stay on the pills for a few months, however, the pain often responds. Unfortunately, once you stop taking the pills, the pain and endometriosis return rather rapidly.
Research studies have shown that while birth control pills are often effective for endometriosis on the surface of the peritoneal membrane lining the abdominal cavity, they are much less effective dealing with endometriosis of the cul-de-sac (the space between the rectum and the vagina). Painful intercourse is less likely to respond to birth control pills than to a GnRH-agonist treatment.