Continuous versus cyclic use of oral contraceptives after surgery for symptomatic endometriosis: a prospective cohort study

ObjectiveTo evaluate the efficacy of continuous oral contraceptive (OC) use versus the usual cyclic fashion in the recurrence of endometriosis-related symptoms after surgery.DesignProspective cohort trial involving patients in two tertiary care units.SettingAcademic institution in collaboration with a private hospital.Patient(s)356 patients underwent surgical treatment by laparoscopy for symptomatic endometriosis.Intervention(s)After surgical treatment for endometriosis, patients offered 6-month course of cyclic OC (including a 7-day pill-free period) or continuous OC.Main Outcome Measure(s)Recurrence rate of endometriosis-related symptoms and endometriomas after fertility-sparing surgery.Result(s)Out of 356 patients, 167 were placed on the usual cyclic OC course and 85 on continuous OC for a minimum of 6 months. The continuous OC group experienced a statistically significant reduction in recurrence rates for endometrioma, dysmenorrhea, and non-menstrual pelvic pain as compared with the cyclic OC group. There was no reduction in the recurrence of dyspareunia between the two groups.Conclusion(s)After surgical treatment of endometriosis, the use of both cyclic and continuous OC improves pain symptoms when compared with preoperative scores. Continuous OC appears to be associated with a reduced recurrence rate for dysmenorrhea, non-menstrual pelvic pain, and endometrioma but not for dyspareunia as compared with cyclic OC.