Is suppressing the ovulatory cycle enough?
According to American Congress of Obstetricians and Gynecologists (ACOG) guidelines:
Persistent symptoms are one reason to move on from initial treatment options, after first-line failure.1
Stopping the menses to reduce dysmenorrhea may not be enough to comprehensively address endometriosis pain.
Once inadequate pain relief on combined oral contraceptives or progestin-only contraceptives is identified, reasess your management plan.2,3
ASK specific questions at every office visit to identify unresolved pain5,6
- How has your pain changed since your last visit?
- Has your pain lessened, or have you just grown accustomed to it?
View therapies for treating this estrogen-dependent disease1,4,7-10:
- Inhibit the COX pathway
- Reduce prostaglandin production
- Decrease inflammation and primary dysmenorrhea
- Combined OCs include both a synthetic progestin and estrogen
- Progestin component helps prevent a rise in estradiol, but synthetic estrogen may result in continued proliferation of endometriosis
- Continuous combined OCs can prevent estrogen fluctuation
- Results in decreased secretion of estradiol and increases androgens
- Decreases estradiol production and improves symptoms
- Inhibit the production of LH and FSH, necessary triggers for stimulating the ovaries to produce estrogen
- Suppress estrogen
- Induce a hypoestrogenic state and improve symptoms
- Unlike healthy endometrium, endometriotic tissue expresses a high level of aromatase activity that may increase estrogen levels and promote the growth of endometriosis lesions
- Because they increase FSH levels and promote follicular development, aromatase inhibitors must be used with additional agents, such as GnRH agonists or combined oral contraceptives, in premenopausal women
- Several small studies have shown aromatase inhibitors to be effective for the treatment of endometriosis and pelvic pain
- Histologic confirmation of disease
- Can effectively relieve painful symptoms
- Symptoms may recur after surgery
- Disease may be difficult to visualize and/or be present outside of the surgical window