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Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen
Open accessAbstract
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.
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“In particular, the continuous use of OC is suggested to achieve amenorrhea and relieve pain at withdrawal bleeding that may still afflict endometriosis patients using OC cyclically (32,33).”
From A stepped-care approach to symptomatic endometriosis management: A participatory research initiative (2018) · cites this paper as [32]
In the citing paper
“Theoretically, the ''regression toward the mean'' phenomenon could have affected the observed data, because extreme values are frequently influenced by random variation and when remeasured they tend to be closer to the mean of the original population from which the study subjects were drawn (32,63).”
From A stepped-care approach to symptomatic endometriosis management: A participatory research initiative (2018) · cites this paper as [32]
In the citing paper
“Therefore, when the patients' conditions are worse than average and standard therapies seem to have lost efficacy, some general amelioration may occur that has nothing to do with improved treatment (32,63).”
From A stepped-care approach to symptomatic endometriosis management: A participatory research initiative (2018) · cites this paper as [32]
Citations
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Crossover and Self-Controlled Designs in Clinical Research
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Self-citationExtending the duration of active oral contraceptive pills to manage hormone withdrawal symptoms
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Chocolate cysts from ovarian follicles
Jain, S., & Dalton, M. (1999) · Fertility and Sterility · doi:10.1016/s0015-0282(99)00367-2 · Cited by 94
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ESHRE guideline: management of women with endometriosis
Dunselman, G. A. J., Vermeulen, N., Becker, C., Calhaz-Jorge, C., D'Hooghe, T., De Bie, B., Heikinheimo, O., Horne, A. W., Kiesel, L., Nap, A., et al. (2014) · Human Reproduction · doi:10.1093/humrep/det457 · Cited by 2,211
Giudice, L. C. (2010) · New England Journal of Medicine · doi:10.1056/nejmcp1000274 · Cited by 1,924
Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications
Stratton, P., & Berkley, K. J. (2011) · Human Reproduction Update · doi:10.1093/humupd/dmq050 · Cited by 442
Treatment of pelvic pain associated with endometriosis: a committee opinion
(2014) · Fertility and Sterility · doi:10.1016/j.fertnstert.2014.02.012 · Cited by 397
Systematic review of endometriosis pain assessment: how to choose a scale?
Bourdel, N., Alves, J., Pickering, G. P., Ramilo, I. D. T. M., Roman, H., & Canis, M. J. (2014) · Human Reproduction Update · doi:10.1093/humupd/dmu046 · Cited by 378
Metadata
- Authors
- Vercellini, P., Frontino, G., De Giorgi, O., Pietropaolo, G., Pasin, R., & Crosignani, P. G.
- Affiliations
- University of Milan (IT)
- Corresponding author
- Vercellini, Paolo
- ORCID
- Vercellini, Paolo
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2003-09
- Volume
- 80
- Issue
- 3
- Pages
- 560-563
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2068661759
- Cited by
- 289
- References
- 6
- Citations by year
- 2026: 9 · 2025: 5 · 2024: 9 · 2023: 3 · 2022: 8 · 2021: 13 · 2020: 12 · 2019: 5 · 2018: 16 · 2017: 15 · 2016: 9 · 2015: 25 · 2014: 12 · 2013: 15 · 2012: 17
- FWCI
- 12.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- endometriosis, dysmenorrhea, desogestrel, ethinyl estradiol, amenorrhea, breakthrough bleeding, treatment satisfaction
- MeSH terms
- Adult, Contraceptives, Oral, Combined, Dysmenorrhea, Endometriosis, Ethinyl Estradiol, Female, Humans, Pain Measurement, Prospective Studies, Patient Satisfaction, Desogestrel, Retreatment, Estradiol Congeners, Progesterone Congeners
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