Contraception and endometriosis: challenges, efficacy, and therapeutic importance

Figures & data

Figure 1 Factors that need to be considered in contraceptive choices for women with endometriosis.

Table 1 Advantages and disadvantages of different contraceptive options in women with suspected or diagnosed endometriosis in order of preference

Method	Estrogen containing	Pain relief	Highly effective contraception	Long-acting	Cycle control	Blood loss	Effect on BMD	Possible functional ovarian cysts
Progestogen only pill	No	Yes	Yes, but compliance problematic	No	Variable	Variable	No	Yes
Subdermal implant	No	Yes	Yes	Yes 3 years	Variable	Variable	No	Yes
LNG IUS	No	Yes	Yes	Yes 5 years	Variable	Reduced	No	Yes
DMPA	No	Yes	Yes	3 monthly	Amenorrhea common	Reduced	Yes but reversible	Rare
COC* continuous	Yes	Yes	Yes, but compliance problematic	No daily use	Variable	Reduced	No	No
COC* cyclic	Yes	Variable	Compliance problematic in adolescents	No daily use	Good	Reduced	No	No
CVR	Yes	Probable	Yes	No monthly	Good	Reduced	No	No
Transdermal patch	Yes	Probable	Yes	No weekly	Good	Reduced	No	No

Note:

* Preferably an estradiol-containing COC.

Abbreviations: BMD, bone mineral density; COC, combined oral contraceptive; CVR, contraceptive vaginal ring; DMPA, depot medroxyprogesterone acetate; LNG, levonorgestrel; IUS, intrauterine system.

Figure 2 Relationship between onset of symptoms and age at diagnosis of endometriosis.

Notes: (A) Age at diagnosis; (B) Age at first symptoms; (C) Diagnostic delay. Figure courtesy of the Victorian Endometriosis Association (Australia) 1990.