Hormonal Contraceptives and Endometriomas

This study shows that a history of hormonal contraceptive use is associated with a lower prevalence of ovarian endometrioma.

Key Points

Highlights:

• This article delineates a study that looks at the relationship between the presence of endometrioma in the ovaries and hormonal contraceptive use in women with peritoneal endometriosis.

Importance:

• It is important to know how hormonal contraceptive interacts with endometriosis. Do the pills exacerbate the patient's condition or does it help prevent the onset of particular symptoms?

What’s done here?

• 136 patient files were pulled from fertility center in Austin, Texas. All of the patients appeared to have peritoneal endometriosis and the information used was the notes at the time of their first laparoscopy.
• After consulting the patient history, the participants were split into two: individuals who have a history of taking a hormonal contraceptive and those who do not.
• The researchers explored the incidence of ovarian endometriomas for both groups.

Key results:

• The group with a history of hormonal contraceptive use had 18.3%  ovarian endometriomas at the time of their first laparoscopy. In the group with no history of hormonal contraceptive use, this figure was 48.8%.
• Thus, it seems that hormonal contraceptive use reduces the prevalence of the endometrioma. The mechanism behind this phenomenon is not understood, but the authors of this study provide two possible explanations:
  • The first is that hormonal contraceptive prevents the corpus luteum from forming, which can be a precursor for an endometrioma.
  • The second explanation is based on the fact that hormonal contraceptive prevents the ectopic endometrium from integrating into the ovary.

Limitations of the study:

• This study was conducted using the information from one fertility clinic. More research would need to be done on a global scale to support the findings of this study.
• Taking oral contraceptives and absence of endometrioma may be a coincidence, rather than a direct causal relationship.

Lay Summary

Hormonal contraceptive has recently become a popular choice of birth control for many women. The European Journal of Obstetrics & Gynecology and Reproductive Biology recently published an article entitled “Incidence of ovarian endometrioma among women with peritoneal endometriosis with and without a history of hormonal contraceptive use” which determines whether there is a link between a history of hormonal contraceptive use and ovarian endometrioma occurrence in women who have peritoneal endometriosis.

Kavoussi et al. went to one fertility clinic and gathered case studies of 136 patients who appear to have peritoneal endometriosis. These patients were then split into two groups: patients that have a history of hormonal contraceptive use and patients who do not. Then they measured the prevalence of ovarian endometriomas for each of the groups.

The results of the study show that women who have a history of hormonal contraceptive use were not as prone to the development of ovarian endometriomas as women who have not taken hormonal contraceptives. The authors of the paper believe that there are two possible explanations for this result. The first is the fact that hormonal contraceptives can prevent the formation of the corpus luteum, which can later turn into an endometrioma. The second explanation relies on the fact that this type of contraceptive prevents retrograde menstruation to some degree, which results in the inability of the ectopic endometrium from becoming a part of the ovary.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28651149