The pill and endometriosis
BIRTH control pills have been widely used to prevent pregnancy, but for women suffering from endometriosis, it provides a cheap and effective method for dealing with the horrific pain accompanying their menses.
Oral contraceptive pills usually contain a low-dose combination of synthetic oestrogen and progestagen which helps to suppress menstruation and inhibit the growth of endometrial implants, believed to be the source of these painful cramps.
“It is not usually my first line of treatment, but if one can use it, you have to use it continuously, you can’t just use it and take the break like how you would normally use it, because then you will still be having a lot of pain,” said gynaecologist Dr Lloyd Goldson.
“You have to use it for about six to nine months to see some effectiveness,” he said, while explaining that a woman can take a break from it after the nine months or if she wishes to get pregnant.
“The pill itself does not affect future fertility… because people with endometriosis have gotten pregnant,” he said.
The pill, which should be taken daily, has continuously been used safely for many years. However, endometriosis patients are susceptible to the same symptoms faced by other women on the pill — like weight gain, irregular vaginal bleeding, nausea, hair growth, acne, fluid retention, headaches, increased appetite and depression.
Endometriosis is a medical issue faced by a number of women in Jamaica and occurs when the tissue that lines the inside of the uterus grows outside on places where it is not supposed to grow, like the organs in the pelvic and abdominal areas.
“One of the theories is that when you see your period, your period is supposed to come through the vagina, but sometimes it can go back through the fallopian tube, so you have a lot of pain. Sometimes you can have pain even in the umbilicus and the bladder,” said Dr Goldson.
Although the endometrial implants are benign (non-cancerous), it causes chronic pelvis pain, lower back and abdominal pain, irregular or heavy bleeding and sometimes infertility.
The cause for endometriosis is still unknown but that has not prevented doctors from prescribing various treatments to deal with the pain and heavy bleeding. Here are the treatments usually suggested.
1. Hormone treatments: these can delay conception if there is a desire to give birth, but they usually lead to the temporary improvement of symptoms such as heavy bleeding, painful periods, pelvic pains and sex during intercourse. These treatments work by suppressing endometriosis by shrinking the endometrial deposits rather than removing it. Some of the hormone treatments include contraceptive pills, progesterone hormone pills, Gonadotrophin-releasing hormone agonists (GnRH agonists) and the drug Danazol.
“Danazol is a good drug that is used to treat endometriosis. You have to use it for about nine months to a year. It is more effective, but it is very expensive too and one of the side effects is that your voice might change a little and you might have more hair growing,” said Dr Goldson.
With regards to the GnRH agonists he had this to say, “It is very effective, but it causes amenorrhea — it doesn’t cause periods for about six months and it costs about $56,000.”
2. The Mirena coil: This helps to reduce the blood flow in a woman’s period. Just like an intrauterine contraceptive device, it is fitted in the womb by a doctor for a fixed amount of time. But as opposed to other forms of IUDs, it actually makes a woman’s period lighter. There are concerns, however, that it could lead to ovarian cysts.
3. Laparoscopy: This is a surgical procedure that attempts to restore the pelvic region to as close to normal as possible. This usually helps to reduce the amount of pain a patient feels during her period.
4. Hysterectomy: This is probably the most extreme option, but the pain associated with endometriosis after proving too unbearable sometimes forces women to undergo this procedure. However, this will not necessarily stop the problem.
