From the Guidelines
Oral contraceptive pills (OCPs) are a first-line treatment option for endometriosis, as they have been shown to be effective in reducing pain and managing symptoms. According to the American College of Obstetricians and Gynecologists (ACOG) recommendations, based on Level B (limited or inconsistent) scientific evidence, oral contraceptives are effective in comparison with placebo and may be equivalent to other more costly regimens for pain relief 1. Combined OCPs containing both estrogen and progestin are typically prescribed in a continuous or extended-cycle regimen to minimize menstruation and associated pain. Common OCPs used include monophasic formulations such as ethinyl estradiol (20-35 mcg) with norethindrone, desogestrel, or drospirenone.
Some key points to consider when prescribing OCPs for endometriosis include:
- Treatment should continue for at least 6-12 months, with many patients requiring longer therapy for symptom management
- Side effects may include nausea, breast tenderness, headaches, and breakthrough bleeding, particularly in the first few months
- OCPs work by suppressing ovulation, reducing menstrual flow, and decreasing the production of prostaglandins that cause pain
- They also inhibit the growth and activity of endometriotic implants by creating a hypoestrogenic environment
- While OCPs can effectively manage symptoms in many patients with mild to moderate endometriosis, they may not be sufficient for severe cases, which might require stronger hormonal treatments or surgical intervention 1.
It's essential to note that the evidence for OCPs in endometriosis management is based on older studies, and more recent research may be necessary to confirm these findings. However, based on the current evidence, OCPs remain a viable treatment option for managing endometriosis symptoms.
From the FDA Drug Label
INDICATIONS AND USAGE Norethindrone Acetate Tablets, USP are indicated for the treatment of secondary amenorrhea, endometriosis, and abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology, such as submucous fibroids or uterine cancer.
- Norethindrone acetate is an Oral Contraceptive Pill (OCP) indicated for the treatment of endometriosis 2.
From the Research
Oral Contraceptive Pills for Endometriosis Treatment
- The combined oral contraceptive pill (COCP) is widely used to treat pain occurring as a result of endometriosis 3, 4.
- A flexible extended dosing regimen, containing drospirenone and ethinylestradiol, may be particularly useful in patients suffering severe dysmenorrhea and improving adherence and compliance with treatment 5.
- Drospirenone/Ethinylestradiol 3 mg/20 mcg seems to be promising in endometriosis management, with significant reductions in dysmenorrhoea and dyspareunia scores and in endometrioma mean diameter observed at follow-up 6.
- The COCP is recommended for endometriosis-associated pain by several national and international guidelines, including the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, and the European Society of Human Reproduction and Embryology 7.
Specific Oral Contraceptive Pills
- Drospirenone/Ethinylestradiol 3 mg/20 mcg is a specific oral contraceptive pill that has been studied for the treatment of endometriosis 6.
- The use of a low-dose oral contraceptive containing Drospirenone/Ethinylestradiol 3 mg/20 mcg, both in cyclic and continuous regimen, has been reported to be effective in reducing endometriosis-related symptoms 6.
Comparison with Other Treatments
- The COCP has been compared to other medical treatments, such as goserelin, but the evidence is limited and of low quality 4.
- There is insufficient evidence to make a judgement on the effectiveness of the COCP compared to other medical treatments, and further research is needed to fully evaluate its role in managing pain-related symptoms associated with endometriosis 4.