Treatment of ovarian endometriosis using low dose oral contraceptive pills.

The treatment of severe endometriosis one of the major causes of infertility and pelvic pain requires prolonged use of expensive medications such as danazol gestrinone GnRH analogs or tamoxifen. Combined medical and surgical therapy is the best approach for treatment when the patient wants to get pregnant. Low-dose estrogen contraceptive pills are used for the treatment of severe endometriosis prior to conservative surgery. Low-dose oral contraceptives can suppress menstruation when used continuously inducing deciduation of the endometrium later followed by atrophy. In the present protocol the endometriotic cysts are punctured prior to the initiation of oral contraceptive therapy using a vaginal ultrasound-guided needle in an office procedure with local anesthesia. Following the puncture and aspiration of the fluid content of the cyst the patient commences a combined contraceptive pill on day 3 to 5 of the menstrual cycle continuously for 6 months. The blood levels of Ca 125 and ovarian steroid hormones are determined during treatment. The majority of women remain amenorrheic throughout treatment with only a few presenting slight spotting. During treatment vaginal ultrasonography is carried out to monitor the effect of treatment on endometrial cysts. As long as the pill is used daily there is usually no growth of endometriotic cysts. Ca 125 levels also decrease in blood at the end of treatment. After 6 months of oral contraceptive therapy the patients undergo laparotomy and removal of the endometriotic cyst. In other cases the removal can be accomplished by video laparoscopy. Preliminary results indicate a 50% pregnancy rate 12 months following surgery which is comparable to the rate obtained with other medications. Oral contraceptive pills have much fewer androgenic side effects than gestrinone and danazol and they do not provoke calcium bone loss as do the GnRH analogs.