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Endometriosis - Management
What advice should I give about contraception?
- If the woman is currently taking hormonal treatment for endometriosis that does not provide contraception, advise her to use a non-hormonal method of contraception to prevent pregnancy.
- Non-contraceptive hormonal treatments include oral medroxyprogesterone, norethisterone, danazol, gestrinone, and gonadotrophin-releasing hormone analogues.
- Contraceptive methods that can be used in women with endometriosis, provided there are no contraindications, include:
- Combined oral contraceptive.
- The levonorgestrel-releasing intrauterine system (Mirena®).
- Depot medroxyprogesterone acetate (Depot-Provera®).
- Progestogen-only pill (such as Cerazette®).
- Etonogestrel-only implant (Nexplanon® [formerly Implanon®]).
- Barrier methods — male or female condom, diaphragm (with spermicide), and cervical cap.
- A copper intrauterine device may worsen dysmenorrhoea but the advantages of this method generally outweigh the risks in women with endometriosis.
- Sterilization should only be undertaken by an experienced surgeon, as severe endometriosis may make access to the fallopian tubes difficult and may increase the risk of complications.
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