Treating endometriosis with birth control
July 28, 2012 1:03 PM   Subscribe

Had an endometrioma surgically removed. Deciding whether to start the pill.

Female, 24. I had a 10cm endometrioma removed via laparoscopy earlier this month. The doctor was able to save my ovary and tube (where the cyst was growing), said the cyst "peeled away" easily, and didn't find endometriosis anywhere else. I haven't had any complications from the surgery and feel loads better. My doctor recommended I start Ortho Tri-Cyclen Lo to minimize future symptoms and said the lifetime risk of recurrence is about 20%. I have a few questions:

1. I have never taken HBC. Are there side effects to starting the pill mid-cycle, other than needing to use backup contraception for the first seven days? My period ended about a week ago and I don't really want to wait another month to start taking the pill, but I also have read that the "Quick Start" method increases the likelihood of breakthrough bleeding and other side effects and don't know how true that is.

2. Endometriosis is incurable, right? Like, even though they didn't find it anywhere else, don't I still have it and won't it get worse over time? Also, if you have endo, how have your experiences been with birth control?

Other background info: I have always had extremely painful menstrual cramps and moderate, seemingly hormonal acne. I do want children eventually and am worried about losing my fertility to endo.

I realize everyone is different, but generally, I'd like to hear others' experiences with endometriosis and birth control. This is all very new to me and health forums on these topics (outside MeFi, I mean) all seem to deterioriate into hysterical worst-case anecdotes that just freak me out. I've avoided HBC in the past because I didn't want to deal with the side effects, but after this ordeal, the possible side effects of BC seem preferable to growing another painful cyst. Thoughts?
posted by perryfugue to Health & Fitness (5 answers total) 4 users marked this as a favorite
IANYD....have you seen your doc for your postop followup yet? These are EXCELLENT questions for your gynecologist!

Hormonal birth control is a very viable option for controlling/treating endometriousis. Be aware that there are different formulations, and some people just do better on different pills. There may be a little trial and error. The pill can help with cramps/acne (again, not everyone experiences this). If you were to start HBC and experience untoward side effects, TALK TO YOUR DOCTOR. You may just need a different pill.

Using hormonal birth control should have minimal effect on your future fertility; indeed, it may help (via limiting further endometrosis).

But again, let me advise you to TALK TO YOUR DOCTOR. Really, these questions are totally reasonable, and your doctor (the one who is recommending HBC) should be happy to discuss the pros & cons.
posted by maryrussell at 1:49 PM on July 28, 2012

Endometriosis is different for everyone, but I can assure you that no, you will not definitely get worse over time.

Also, an anecdote from my mother's experience is that she had been suffering from infertility for 5 years, then had a large endometrioma removed from a similar location, and got pregnant the next month (and never had trouble getting pregnant again). She also never had surgery again for it nor did I ever hear her complain of symptoms from endometriosis during my lifetime.

Starting the pill mid cycle could be more likely to make you end up with some spotting (it is true), but otherwise it's fine. Which pill is it? If it's one of the very low hormone ones you probably have more chance of the spotting/breakthrough bleeding, if it has more hormones in it then you might be more likely not to have a problem.
posted by treehorn+bunny at 1:52 PM on July 28, 2012

It worked for me. Laparoscopic surgery for endometriosis at age 25. Ortho/Novum 1/35 until age 32. Conceived a month after we started trying. Had another baby at age 36. I don't know what would have happened without the contraceptive pills to prevent regrowth of the endometriosis.

I strongly agree about trying different oral contraceptives if the first ones you try don't agree with you. None of the other brands ever suited me as well as good old Ortho Novum 1/35. Different women prefer different formulations.
posted by artistic verisimilitude at 2:17 PM on July 28, 2012

I have endometriosis and had extremely painful periods except when I was on bcp. Yes there are potential side effects but also, different pills have different combinations of hormones, so if you need to, you can experiment with a few until you find one that's good for you. Eventually I was able to go on a mono-phasic pill for 3 months at a time and have a period 4 or 5 times a year. AWESOME. No pms. Being on bcps was one of the best things about becoming an adult.

I did have fertility problems when I went off the pill and tried to conceive, problems probably due to the endometriosis. But the specialists I talked to told me that being on the pill had probably prevented the endometriosis from being more of an issue than it was.

Good luck!
posted by bq at 2:26 PM on July 28, 2012

Thanks for your answers! Yes, I have had my followup appointment... but didn't have the presence of mind to ask these questions because much of the visit was spent discussing the pathology of the cyst. (All I knew immediately post-op was that I had a cyst with blood/solids in it, so until the lab results were in my doctor couldn't tell me if it was an endometrioma or a functional ovarian cyst that bled into itself. Yuck.)

I'd still like to hear more experiences if anyone wants to share, but I am probably going to just take the plunge and start taking the Ortho Tri-Cyclen Lo. Only way to find out how I'll react, right? :)
posted by perryfugue at 10:01 AM on July 29, 2012

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