Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen

Abstract

Objective To ascertain whether long-term reduction of pain is obtained by continuous administration of an oral contraceptive (OC) in women with endometriosis-associated recurrent dysmenorrhea that does not respond to cyclic OC use. Design Prospective, therapeutic, self-controlled clinical trial. Setting A tertiary care and referral center for patients with endometriosis. Patient(s) Fifty women who underwent surgery for endometriosis in the previous year and experienced recurrent dysmenorrhea despite cyclic OC use. Intervention(s) Continuous use of an OC containing ethinyl estradiol (0.02 mg) and desogestrel (0.15 mg) for 2 years. Main outcome measure(s) Dysmenorrhea variation during cyclic and continuous OC use, evaluated with a 100-mm visual analog scale and a 0- to 3-point verbal rating scale, and degree of satisfaction with continuous OC treatment. Result(s) In the study period, amenorrhea, spotting, and breakthrough bleeding were reported by 19 (38%), 18 (36%), and 13 (26%) women. The mean ± SD number of >7-day bleeding episodes with consequent 7-day OC suspension was 5.5 ± 2.1. The mean ± SD dysmenorrhea visual analog scale and verbal rating scale scores were 75 ± 13 and 2.4 ± 0.5 at baseline and 31 ± 17 and 0.7 ± 0.6 at 2-year follow-up, respectively. Moderate or severe side effects were reported by 7/50 (14%) women. At final evaluation, 13 (26%) women were very satisfied, 27 (54%) were satisfied, 1 (2%) was uncertain, 8 (16%) were dissatisfied, and 1 (2%) was very dissatisfied. Conclusion(s) Long-term continuous OC use can be proposed to women with symptomatic endometriosis and menstruation-related pain symptoms.