Birth control pills for the treatment of chronic pelvic pain

Examples

Generic Name	Brand Name
estrogen/progestin combination pills	Brevicon, Demulen, Levlen, Lo/Ovral, Modicon, Nelova 1/35, Nelova 10/11, Nordette, Norethin 1/35E, Norethin 1/50M, Norinyl 1+35, Ortho-Novum 1/35, Ovcon, Tri-Levlen, Tri-Norinyl, Triphasil
progestin-only pills	Micronor, Nor-Q.D., Ovrette

How are these medications taken?

For information on progestin injections, see the Medications section of the topic Chronic Female Pelvic Pain.

How It Works

Birth control pills control female pelvic pain by:¹

• Stabilizing the production of the hormones that stimulate endometrial growth (estrogen and progestin).
• Preventing ovulation.
• Decreasing the amount of blood loss during the menstrual period.
• Stopping the menstrual periods for long periods of time when the continuous 15-week regimen is used.

Why It Is Used

Birth control pills may be used before a laparoscopy (surgical procedure for investigating the source of pelvic pain) when:

• Symptoms are mild to moderate.
• Birth control is desired.

Birth control pills may be used after a laparoscopy to help prevent the recurrence of pelvic pain.

How Well It Works

Effect on menstrual period symptoms

• Menstrual periods are usually less painful with lighter flows.
• Young women with very painful menstrual periods and minimal to mild endometriosis usually report improvement when taking oral contraceptives continuously for 15 weeks without breaks for menstrual bleeding.

Effect on fertility

Pregnancy rates may not improve after treatment with birth control pills is stopped.¹

Recurrence

Female pelvic pain may return when you stop taking birth control pills.

Side Effects

Birth control pills have been studied extensively and are considered very safe.

More common side effects include changes in menstrual periods, such as very light or skipped periods or spotting (bleeding between periods).

Less common side effects include:

• Nausea and vomiting, especially in the first month of use. This side effect usually goes away after the first few months of use or can be prevented by taking the pill with a meal.
• More frequent or more severe headaches. Migraine headaches may get worse.
• Weight gain.
• Breast tenderness for the first few months.
• Depression or mood changes.
• Darkening of the skin on the upper lip, under the eyes, or on the forehead (chloasma). This may slowly fade after the woman stops taking the pills, but in some cases, it is permanent.
• Decreased interest in sex.

Rare but serious side effects

The following symptoms, called ACHES, are rare but serious and should be reported to your health professional immediately.²

• Abdominal pain may be a sign of blood clots (thrombophlebitis) in the pelvis, liver blood clots or tumors, or gallbladder disease.
• Chest pain may be a sign of blood clots in the lungs (pulmonary embolism), heart attack or heart disease, or breast tumors. Smoking increases this risk.
• Headaches that are severe may be a sign of stroke, migraine, or hypertension. Smoking increases this risk.
• Eye problems, such as blurred vision or loss of vision, may be a sign of migraine, eye blood clots, or a change in the shape of the cornea.
• Severe leg pain may be a sign of leg blood clots (thrombophlebitis) or deep vein thrombosis (DVT).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Birth control pills may control the progression of female pelvic pain, but they do not cure it. They may not reduce symptoms in all women. You may use birth control pills until menopause is completed, if no risk factors are present. Birth control pills are generally not recommended if you have any of the following conditions:

• Uncontrolled high blood pressure
• Liver disease
• History of blood clots in a vein (deep vein thrombosis) or lung (pulmonary embolism)
• History of stroke
• A clotting disorder

Birth control pills are generally not recommended for women over the age of 35 who have diabetes or who smoke.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Author:	Kathe Gallagher, MSW	Last Updated: January 30, 2007
Medical Review:	Renée M. Crichlow, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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