Despite Lack of Efficacy, Birth Control Drugs Remain First Treatment for Endometriosis

For almost 70 years, combined estrogen-progestin birth control pills have been a first line treatment for symptoms associated with endometriosis. Like most pharmaceutical drugs, the widely used treatment is a band aid approach. For women with endometriosis, even more frustration is met by the fact that there is no clinical evidence of efficacy and for many, the hormonal contraceptives cause undesired side effects such as depression, weight gain, and headaches.^{1 2}

Endometriosis Believed to Increase Risk of Autoimmune Disease

Endometriosis is an estrogen-dependent serious inflammatory disease that affects approximately one in 10 women in the United States. Although, it is suspected that this rate is much higher since endometriosis is chronically underdiagnosed as women are often told they just have “painful periods.”

It occurs when tissue that is similar to the inner lining of the uterus, known as endometrium tissue, grows outside of the uterus. Symptoms of endometriosis include severe cramps, chronic pelvic pain, heavy menstrual periods, and infertility. Bands of fibrous tissue known as adhesions may also form, causing pelvic tissues and organs to stick to each other. In addition, modern evidence points to significant rates of miscarriage and pre-term birth in endometriosis patients.³ While endometriosis is not classified as an autoimmune disease, endometriosis is thought to increase a person’s risk of developing an autoimmune disease as well as other chronic conditions.⁴

Commonly recommended treatments include NSAIDS (non-steroidal anti-inflammatory drugs such as ibuprofen, hormonal birth control, progestin-only contraceptives, and GnRH analogues which cause your ovaries to stop producing estrogen.⁴  For many women, oral contraceptives initially experience improvement, but the results typically do not last, if they even work at all. Studies on women with pelvic pain have remarked on the ineffectiveness of the pill for helping with pain.¹

One journal article discussing research of contraceptives in endometriosis concluded: “In conclusion, once endometriosis is suspected or proven as the cause of chronic pelvic pain, an OCP may not be the best treatment option and could potentially lead to progression of the disease. The beneficial effect of OCPs observed in the past may have been entirely due to relief of primary dysmenorrhea with little or no beneficial effect on the underlying endometriosis.”⁵

Despite a lack of successfully helping manage endometriosis, guidelines for the management of endometriosis from every gynecologic society, including the American College of Obstetrics and Gynecology, the American Society for Reproductive Medicine (ASRM), the European Society for Human Reproduction and Endocrinology (ESHRE), and the Canadian Fertility and Andrology Society (CFAS), regard oral contraceptives as the initial treatment for pain and dysmenorrhea associated with endometriosis when the patient is not responsive to nonsteroidal anti-inflammatories such as ibuprofen.⁵

Contraceptive Prescriptions for Endometriosis Began in 1950s Using Dangerously High Doses

There is also a lack of placebo controlled clinical trials demonstrating effectiveness of contraceptives for pelvic pain and dysmenorrhea in women with endometriosis. The origins of prescribing birth control for endometriosis or pelvic pain date back to the 1950s. In 1957, the FDA approved the birth control pill Enovid for treatment of endometriosis. The doctor who concluded that contraceptives were a treatment for endometriosis did so by administering dangerously high dosages of the drugs to induce states of “pseudopregnancy” which suspended ovulation, resulting in a decrease in menstrual pain symptoms. The dosages used were well above those that produced thrombosis and death in early contraceptive pill users. In a Senate testimony in 1970, that same doctor admitted to being paid for consulting “practically all of the [drug] companies” making contraceptives.¹

Current ACOG recommended treatment of endometriosis include medications such as NSAIDs or hormonal medications like birth control, surgery, or a combination of both. Neither approach cures endometriosis, often only temporarily treating pain.⁶

Chinese Medicine Success in Treating Endometriosis

Allopathic medicine is notorious for addressing symptoms without further considering the root cause, which is likely why both surgery and medication are only temporarily effective for many women.

Two small clinical trials done by researchers at the Hospital of Obstetrics and Gynecology of the Shanghai First Medical College found that various Chinese herbs were successful in “mostly or entirely” relieving endometriosis-related pain in 82 percent of participants. The herbs used in the trials may work by helping to regulate pelvic blood, as well as modulate immune system activity and inflammation.⁷

“I think the positive message is that Chinese herbal medicine may offer equivalent benefits to conventional medicine but with fewer side effects,” lead researcher Andrew Flower, of the University of Southampton in the U.K., told Reuters Health. “This may mean that Chinese herbal medicine is more suitable for long-term use.”⁷

Acupuncture is another alternative treatment that research suggests may be effective in managing endometriosis. Six studies involving a total of 331 participants were evaluated to conclude that acupuncture treatment demonstrated clinically relevant improvements of pelvic pain “and should be considered as a potential treatment intervention.”⁸

Research and Healthcare for Women Historically Lacking

For as long as modern medicine has relied on research, there has been a significant lack of research in women’s health. Before 1993, women were rarely included in clinical trials and throughout history, doctors have considered men’s bodies as the norm and women’s bodies as atypical. For many years, research has predominantly focused on males, leaving a large gap in conditions that primarily effect women such as endometriosis.⁹ In addition, women’s suffering has historically been downplayed or misinterpreted by medical professionals, often diagnosed with “hysteria” or “nervous conditions”.¹⁰

Pharmaceutical Industry Influences Physician Recommendations.

A cross-sectional analysis of 600 of the most-cited clinical trials published since 2018 found that pharmaceutical industry involvement was frequent, most often in the form of funding, authorship, and conclusions favorable to the sponsor. Major medical associations, including ACOG, also list pharmaceutical companies among their largest corporate donors.⁹

Given the degree of industry influence, it remains unlikely that ACOG will recommend alternative therapies such as herbal medicine, dietary modification, or acupuncture. This dynamic has implications for the more than 6.5 million women in the United States living with endometriosis, many of whom experience chronic pain, infertility, and other significant adverse health outcomes.¹¹

If you would like to receive an e-mail notice of the most recent articles published in The Vaccine Reaction each week, click here.