Hi from the East Coast-
For someone in her early 40s (hoping to maintain fertility) with endometriosis and beginning signs of adenomyosis, would you recommend birth control pills to keep adenomyosis at bay? (Note: the pill has previously been effective in keeping the endometriosis very quiet.)
If you do recommend the pill for the above- I've responded well to Mircette (low dose) but would you have concerns about increased blood clot risk with third generation pills in a non-smoker now past 40? I took it throughout my 30s.
Thank you for your expertise!
Hello Lindsay from the U.S. (New York),
If you are in your early 40's, your fertility is already compromised by your age. We call that the "age factor" which is the significant decline in fertility after the age of 35 years old. For example, a woman under 30, has an 85% chance of pregnancy per year. At 40, it is 10% per year. That is going to be your major obstacle. So, if you are asking the question because you want to maintain FUTURE fertility, it may not make much difference because your fertility rate is declining rapidly over time and further waiting only reduces the chances further.
That being said, the main treatment for endometriosis, which is a pelvic disease, is to remove the large lesions by laparoscopy and follow with some type of estrogen blocker such as Lupron. The second choice would be Depo provera (progesterone) and the last choice would be birth control pills(which have both estrogen and progesterone). The problem with the pill is that endometriosis grows under the influence of estrogen and the pill has estrogen, in higher doses, within it. This tactic only buys some time and does not eradicate the disease. It will eventually recur. Adenomyosis, which is endometriosis within the muscle layer of the uterus, is a much more difficult problem and there is no treatment. Birth control pills can help to stave off some of the symptoms (increased cramping), but cannot and does not treat or eradicate the disease. Adenomyosis does not tend to influence pregnancy rates. The only treatment for suspected Adenomyosis is hysterectomy, and Adenomyosis can only be diagnosed pathologically after hysterectomy.
If you are considering pregnancy, then my recommendation would be to move toward aggressively trying to get pregnant now. Aggressively would mean some type of assisted reproductive treatment, and the treatment of choice (in consideration of age and endometriosis) would be IVF. If you are over 42 years old, then using donor eggs in conjunction with IVF would give you the highest chances for pregnancy although that is not absolutely necessary. You certainly could try with your own eggs with the understanding that the chances of success are low.
In terms of taking the pill after the age of 40, unless you have some actual contraindication such as a clotting disorder or have had a stroke or venous clot (DVT), then the risks are minimal and can be safely taken.
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com
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