Post operative long-term use of cyclic vs. continuous oral contraceptives for pain management and prevention of symptom-recurrence in endometriosis: a randomized controlled trial

Endometriosis places a significant social and economic burden on patients, their families and society, affecting nearly 10% of women worldwide. There remains a lack of disease awareness partly because of the stigma behind women’s menstrual pain and largely on the lack of knowledge of the disease and pathogenesis. The current treatment includes oral contraceptive pills and laparoscopic surgery which although extensively studied, lacks the research trials to represent adverse events and prevalence of post-surgical pain as well as time to recurrence of pain symptoms post-surgery. The search for the most effective long-term treatment for endometriosis continues to be a topic of promising research. There remains limited research on the true cause and the best treatment available for endometriosis long-term to keep women symptom free. New avenues of research show encouraging therapy options including OCP use after Laparoscopic surgery to prevent recurrence of dysmenorrhea, dyspareunia, and chronic pelvic pain symptoms. However, the current handful of trials and research studies have limited success, proving there is an inadequate understanding of the most effective long-term therapy to ensure the best quality of life and reduction of pain recurrence. The proposed study is a randomized, double-blinded, longitudinal controlled trial with the goal to assess the long-term use of cyclic vs. continuous oral contraceptive pills after Laparoscopic surgery for treatment of endometriosis and reduction of recurrence of symptoms. The intervention will randomly assign post-laparoscopic surgery stage 3-4 endometriosis patients into 3 treatment arms composed of a continuous or cyclic birth control pill vs. a placebo pill. Follow-up will be by means of an email survey consisting of a VAS score to grade pain symptoms every 3 months for a total of 36 months. Time to recurrence of symptoms if present and overall pain symptoms including dyspareunia, dysmenorrhea, and chronic pelvic pain will be assessed and analyzed over the 36 months with the help of a trained research assistant. If successful, this study would lead to the establishment of a new standard of care for patients with endometriosis helping to keep them symptom free long-term, as well as lessen their dependence on the healthcare system overtime reducing the associated economic burden.