Continuous versus cyclic use of oral contraceptives after surgery for symptomatic endometriosis A prospective cohort study

Capsule:
Continuous use of oral contraceptives after surgery is associated with a statistically significant reduction in dysmenorrhea, non-menstrual pelvic pain, and endometrioma recurrence.

Authors:
Nikos Vlahos, M.D., Athanasios Vlachos, M.D., Olga Triantafyllidou, M.D., Nikolaos Vitoratos, M.D., George Creatsas, M.D.

Volume 100, Issue 5, Pages 1337-1342, November 2013

Abstract:

Objective:
To evaluate the efficacy of continuous oral contraceptive (OC) use versus the usual cyclic fashion in the recurrence of endometriosis-related symptoms after surgery.

Design:
Prospective cohort trial involving patients in two tertiary care units.

Setting:
Academic institution in collaboration with a private hospital.

Patient(s):
356 patients underwent surgical treatment by laparoscopy for symptomatic endometriosis.

Intervention(s):
After surgical treatment for endometriosis, patients offered 6-month course of cyclic OC (including a 7-day pill-free period) or continuous OC.

Main Outcome Measure(s):
Recurrence rate of endometriosis-related symptoms and endometriomas after fertility-sparing surgery.

Result(s):
Out of 356 patients, 167 were placed on the usual cyclic OC course and 85 on continuous OC for a minimum of 6 months. The continuous OC group experienced a statistically significant reduction in recurrence rates for endometrioma, dysmenorrhea, and non-menstrual pelvic pain as compared with the cyclic OC group. There was no reduction in the recurrence of dyspareunia between the two groups.

Conclusion(s):
After surgical treatment of endometriosis, the use of both cyclic and continuous OC improves pain symptoms when compared with preoperative scores. Continuous OC appears to be associated with a reduced recurrence rate for dysmenorrhea, non-menstrual pelvic pain, and endometrioma but not for dyspareunia as compared with cyclic OC.

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