Once endometriosis has been overcome with surgery or assisted reproduction, the patient faces the future. Endometriosis is a chronic inflammatory condition. It is somewhat like an infection without the bacteria.
Much research has been done on the effect of the disease on neighboring reproductive tissue. The tissues react and secrete molecules which can be considered toxins which in animal experiments are known to interfere with sperm, eggs or embryos. No one can see this in action in humans, but the mechanisms are likely to be similar. The implants also cause pain with periods, or at other times. Also cysts may develop on the ovaries.
One should not rest easy and assume the problem is cured after a successful pregnancy.
It is never really cured It has been estimated by my old friend from residency days at the University of Pennsylvania, Alan Decherney MD that the recurrence risk is about 15% per year. Others have similar estimates, making it imperative that the patient consider active management of the disease. Certainly if a baby has been born, the endometriosis is ideally suppressed by the 9 months of high dose of Mother Natures best hormone treatment. After the baby, longer months of breast feeding would favor continued suppression of ovulation. Ovulation is the trigger for more development of endometriosis.
Thus, after lactation is completed, one should either start trying to conceive quickly or suppress ovulation through other means. There are a number of drugs which have been used. The tried and true are birth control pills and progesterone derivatives or progestins. Norethisterone acetate is the most common of the progestins. Other options include DepoProvera injections which last for months, but should not be chosen if future children are planned reasonably soon.
The combined estrogen and progesterone pills can be taken to advantage in a 3 month regimen, non-stop. That’s about as long as they can y be used without annoying breakthrough bleeding. Though not tried specifically for endometriosis, the new 3 month tricyclic birth control pills logically should work just fine.
Plan to suppress ovulation most of the time until menopause. Some recurrence may occur despite therapy, but this an inexpensive regimen with low side effects.
Joe Massey MD
CNY Fertility Center
Decherney AH Endometriosis: recurrence and retreatment Clin Therap 1992:14; 766-772.