Endometriosis oral contraceptives

Endometriosis Oral contraceptive, depot injection of medroxyprogesterone acetate, GnRH agonist, danazol... 

Thus, our attention should shift from the concern of potential adverse effects to the health benefits imparted by hormonal contraceptives. The use of oral contraceptives for at least 12 months reduces the risk of developing endometrial cancer by 50%. Furthermore, the risk of epithelial ovarian cancer in users of oral contraceptives is reduced by 40% compared with that on nonusers. This kind of protection is already seen after as little as 3-6 months of use. Oral contraceptives also decrease the incidence of ovarian cysts and fibrocystic breast disease. They reduce menstrual blood loss and thus the incidence of iron-deficiency anemia. A decreased incidence of pelvic inflammatory disease and ectopic pregnancies has been reported as well as an ameliorating effect on the clinical course of endometriosis. 

The progestins are used in the treatment of amenorrhea, endometriosis, and functional uterine bleeding. Progestins are also used as oral contraceptives, either alone or in combination with an estrogen (see the Summary Drug Table Female Hormones and Table 52-1). 

Like the medical treatment of uterine leiomyomas, danazol, gestrinone, mifepristone, and GnRH-a, with or without add-back therapy, have been proposed for the treatment of endometriosis as well (Olive et al. 2001 Stones et al. 2004), but unlike leiomyomas, oral contraceptive pills, in cyclic or continuous administration, and medroxyprogesterone acetate also seem to be effective (Olive et al. 2001 Stones et al. 2004). A significant benefit in terms of pelvic pain relief also is obtained with the use of nonsteroidal anti-inflammatory drugs (Olive et al. 2001 Stones et al. 2004). 

Norethisterone Synthetic progestogen Abnormal uterine bleeding. Endometriosis, component of some oral contraceptives and in hormone replacement therapy... 

It has become apparent that reduction in the dose of the constituents of oral contraceptives has markedly reduced mild and severe adverse effects, providing a relatively safe and convenient method of contraception for many young women. Treatment with oral contraceptives has also been shown to be associated with many benefits unrelated to contraception. These include a reduced risk of ovarian cysts, ovarian and endometrial cancer, and benign breast disease. There is a lower incidence of ectopic pregnancy. Iron deficiency and rheumatoid arthritis are less common, and premenstrual symptoms, dysmenorrhea, endometriosis, acne, and hirsutism may be ameliorated with their use. 

Epidemiological studies of the relation between oral contraceptive use and pelvic endometriosis have variously shown an increased risk, a reduced risk, and no effect (268). For example, an Italian study showed an increased risk among ever users of oral contraceptives, but this increase occurred only among former users, not current users (269). Furthermore, the authors noted that a similar pattern had been shown in several large cohort studies (OFPA, RCGP, and Walnut Creek). There was no association in the Italian study with recency, latency, or... 

All medical therapies (nonsteroidal anti-inflammatory drugs, oral contraceptives, progestins, danazol, or gonadotropinreleasing hormone agonists) are equally efficacious in treating endometriosis-related pain based on available evidence. Choice among agents is determined primarily by side-effect profile, cost, and individual patient response. 

Vercellini P, Trespidi L, Colombo A, et al. A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis. Fertil Steril 1993 60 75-79. 

Oral contraceptives have major benefits related to menstruation, including more regular menstruation, reduced menstrual blood loss and less iron-deficiency anemia, and decreased frequency of dysmenorrhea. There also is a decreased incidence of pelvic inflammatory disease and ectopic pregnancies, and endometriosis may be amehorated. 

The manufacturer also suggests that if combined oral contraceptives are used for reasons other than contraception (e.g. endometriosis), that the therapeutic effect should be monitored and the dose increased if necessary. These precautions seem prudent. 

Cheewadhanaraks S, Choksuchat C, Dhanaworavibul K, Liabsuetrakul T. Postoperative depot medroxyprogesterone acetate versus continuous oral contraceptive piUs in the treatment of endometriosis-associated pain a randomized comparative trial. Gynecol Obstet Invest 2012 74(2) 151-6. 

Anti-inflammatory, treatment of asthma, allergic reactions, immunosuppressant Anti-inflammatory, immunosuppressant, 20-30 times as potent as cortisol, 4-5 times mae effective than prednisolone. Treatment of rheumatoid arthritis, multiple myeloma Oral contraceptive Long-term injectable contraceptive, management of endometriosis... 

Progestins are nsed for varions menstmal cycle disorders, for functional uterine bleeding of various origins, and as a contraceptive. Progestin therapy is also used to treat endometriosis and endometrial carcinomas. Progesterone is not effective when taken orally due to intensive metabolism, and therefore it is used by either parenteral or transvaginal introduction. 

Clinical use A major therapeutic use of the progestins is as a component of oral or implantable contraceptives. They are used in HRT to prevent estrogen-induced endometrial cancer. Large doses of medroxyprogesterone can be used to produce anovulation and amenorrhea in women with dysmenorrhea, endometriosis, or bleeding disorders. 

---