Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen

Objective: To ascertain whether long-term reduction of pain is obtained by continuous administration of an oral contraceptive (OC) in women with endometriosis-associated recurrent dysmenorrhea that does not respond to cyclic OC use. Design: Prospective, therapeutic, self-controlled clinical trial. Setting: A tertiary care and referral center for patients with endometriosis. Patient(s): Fifty women who underwent surgery for endometriosis in the previous year and experienced recurrent dysmenorrhea despite cyclic OC use. Intervention(s): Continuous use of an OC containing ethinyl estradiol (0.02 mg) and desogestrel (0.15 mg) for 2 years. Main Outcome Measure(s): Dysmenorrhea variation during cyclic and continuous OC use, evaluated with a 100-mm visual analog scale and a 0- to 3-point verbal rating scale, and degree of satisfaction with continuous OC treatment. Result(s): In the study period, amenorrhea, spotting, and breakthrough bleeding were reported by 19 (38%), 18 (36%), and 13 (26%) women. The mean ± SD number of >7-day bleeding episodes with consequent 7-day OC suspension was 5.5 ± 2.1. The mean ± SD dysmenorrhea visual analog scale and verbal rating scale scores were 75 ± 13 and 2.4 ± 0.5 at baseline and 31 ± 17 and 0.7 ± 0.6 at 2-year follow-up, respectively. Moderate or severe side effects were reported by 7/50 (14%) women. At final evaluation, 13 (26%) women were very satisfied, 27 (54%) were satisfied, 1 (2%) was uncertain, 8 (16%) were dissatisfied, and 1 (2%) was very dissatisfied. Conclusion(s): Long-term continuous OC use can be proposed to women with symptomatic endometriosis and menstruation-related pain symptoms.