Hormonal contraceptives for the medical treatment of endometriosis

Hormonal contraceptives for the medical treatment of endometriosis

P.G. Crosignani

Department of Obstetrics and Gynecology, University of Milano, Milano,


Drugs used in the treatment of endometriosis are not cytoreductive and

quiescent implants have been demonstrated in nearly all women treated with

danazol, GnRH agonists and progestogens.

Medical therapy is symptomatic and pain release at treatment suspension is

the rule.

Hormonal contraceptive preparations are effective in controlling pain

symptoms in approximately three out of four women with endometriosis. Their

effect does not seem to be inferior to that obtained with other drugs habitually

used in treating the disease. Medical treatment plays a role in the overall

therapeutic strategy only if it can be administered over a prolonged period of

time. Given their good tolerability, minor metabolic effects and low cost,

hormonal contraceptives must therefore be considered the drugs of choice.

The effectiveness of hormonal contraceptives is probably partly due to the

proven anti-inflammatory effect of progestogens. Most pelvic lesions associated

with endometriosis are secondary to the strong inflammatory state caused by the

metabolic activity of ectopic endometrium and to the resulting immune response.

Furthermore, patients with endometriosis experience heavier menstruations than

women without the disease. The reduction of menstrual flow observed with the use

of OC or the levonorgestrel IUD can limit pelvic contamination caused by

transtubal reflux.

Hormonal contraceptives are currently the only safe and inexpensive

alternative to surgery. However, their contraceptive activity limits their use

to women who do not wish to have children in the short term.

Scroll to Top