QuestionHello. My question is concerning birth control as a treatment for endometriosis...
I've had severe cramps ever since my period began at 13. I am 22 now and they are only getting worse. The pain is horrible. Lately I've resorted to purchasing pain pills (tylonol 3) off a friend of mine who just has a c-section. My husband and I do not have insurance and can't afford it right now. We're both in college and struggling just to make rent every month. We do have a Family Physician who is a close friend of my husband's family and he has mentioned endo. He says he is incapable of making a definite diagnosis, but he is pretty sure that is what it is. I have almost every symptom, painful periods, heavy blood, painful intercourse, etc. I tell my husband the pain isn't just in my abdomen, but everywhere. It's like I've slipped into a pair of Pain-Underwear. Anyway, sorry I'm rambling...My doctor suggested that I take birth control to alleviate the symptoms. I'm not so sure about this. I can't afford to see a gyno and be properly diagnosed and treated, even though I know that's what I need. Birth control, my doctor says, is my only option beyond finding insurance (or money) for a gyno.
I guess my question is, does birth control work for endo? I realize it won't cure it, just calm it down for the time being. And I know the pain will begin again as soon as I quit. But I'm only looking at it as a short-term solution. Also, would you know about whether continuous or cyclic birth control would be better? My doctor claims that taking birth control continuously is not suggested, but all over the internet I've read about it being helpful in endo cases. I'm just so confused.
Any help you could offer would be greatly appreciated. Also, my husband and I were planning on trying to have a baby within a year, when we have both graduated. I've read that endo can inhibit your ability to concieve. We have been having unprotected sex for the past 4 years with no babies, so I assume it is the endo. I worry I will have trouble starting a family. I know you can't get pregnant on any of the hormones usually prescribed for endo, so I am confused as to how to ever begin. Seems I'm stuck between a rock and a hard place, you know what I mean?
I'm sorry this question is so long. I really appreciate your time and wny help you can offer. Thanks.
Chrissie Heldon
AnswerIt is sometimes difficult to diagnose endometriosis. It is very difficult to do so without examining you. Endometriosis is the presence of endometrial tissue outside the uterus. Often there are implants on the fallopian tubes or ovaries or abdominal wall. The symptoms are pelvic pain, pain with your period, pain while having sexual intercourse, and infertility. The pain that we see in endometriosis is often deep in the pelvis around the rectum or below the uterus (centrally) On examination, we usually feel a "nodularity" on the uterosacral ligaments or painful rectovaginal septum. HOwever, often we feel no evidence at all. Although sonograms and CT scans may be helpful, the only definitive diagnosis is made after laparoscopy or laparotomy when we actually visualize the implants. Medical therapy is aimed at suppressing ovarian estrogen stimulation.Oral contraceptives cause anovulation and atrophy of endometrial tissue. Symptomatic relief of pelvic pain and dysmenorrhea (pain during sex) is achieved in 60-90% of patients. (Pain is increased, however, for the first few weeks of treatment). I would suggest triphasic birth control pills of a low dose variety. They will do as well as the continuous high dose variety, and you will not be exposed to too much estrogen. Since we really do not know if you have endometriosis or merely severe dysmenorrhea, I would start on the birth control pills and try to use ibuprofen (Advil, Motrin, etc), at leas 600mg every 6 hours. Try starting the day prior to the onset of your period and you will avoid a buildup of prostaglandins and avoid some of the discomfort. One of the cures for endometriosis is to become pregnant. Once you conceive, your symptoms will recede and disappear. I would really try to save up some money or get some insurance and see a gyneclogist as soon as you can so that you can get a diagnosis and prepare for becoming pregnant. Good luck to you.
