A BC pill for both endometriosis treatment & atherosclerosis prevention?!

Wow, good question! I can't be sure of the answer, but I do believe there is no such pill. If there were, we'd have heard about it and it would be BIG news. The problem is that oral estrogen raises LDL and lowers HDL due to the process of being processed by the liver, at least in part. But it's not completely well understood. And the non oral hormonal birth controls--Nuva Ring and Ortho Evra patch--have this effect, too. I think it might be partly related to the fact that virtually all the birth control pills and patches and vaginal ring contain ethinyl estradiol. Transdermal estradiol does not appear to have the bad effects on LDL and HDL that ethinyl estradiol and the oral estrogens have. But for some reason they only give transdermal estradiol to menopausal women. I think it's because estradiol has a shorter half-life than ethinyl estradiol, and they need the longer half-life of ethinyl estradiol for the pill to be effective as birth control. Again, though, I'm not sure of this. I wouldn't even bother answering, since what good would it do, except that telling you my speculations may help guide you in your own research and get you to check some of this stuff that way.

Meanwhile, the mechanisms by which the BC pills prevent ovarian cancer and help endometriosis are different. Ovarian cancer is most likely prevented by preventing you from ovulating. Biopsies of ovaries with ovarian cancer show that a large percentage of the cancers appear to have started in inclusion cysts left in the place where an egg was released. For most of our evolutionary history, women only ovulated a few months in a row, then got pregnant and breast fed for several years, during which time they didn't ovulate and the ovaries had time to heal from the inflammation and damage of releasing an egg. Now, we ovulate every month for 40 years, with only a few times when that is interrupted for pregnancy. The damage to the ovaries is frequent and repetitive. But with BC pills, we can prevent ovulation and thereby prevent the cellular damage leading to ovarian cancer.

With endometriosis, a more balanced estrogen-progesterone profile might exist than that which the woman normally has. Or perhaps it keeps the lining from getting too thick.

In any case, most who take BC pills are younger, and atherosclerosis is not a major concern. When they stop the pill, things will go back to normal and risks will decrease. In other words, no permanent damage. However, the ovarian cancer risk goes down permanently if taking birth control pills, and endometriosis severity can also be reduced or delayed, which is a long-term benefit. So it's perhaps worth the short term miniscule increase in risk to obtain lifetime benefits in other ways.

This problem has not yet been determined. Some believe that the risk of heart disease goes up but this has been studied with women who used to take birth control and birth control has drastically changed over the years to use lower doses of hormones. Some believe that they hormones don't increase risk but might help pre-menopausal women (after menopause the risk of all women's heart disease risk goes up) and this might be due to estrogen's protective effect. And one of the studies done on modern birth control pills suggest that their is no link at all between birth control and heart disease. So, this is not yet conclusive.

If you are still worried, you can talk to your doctor about non-oral forms of birth control such as the patch, implanton, nuva ring, or an IUD to see if any of those would help your endometriosis.

Hi,
Treatment for endometriosis is usually with medications or surgery.

Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.

Pain medications
Your doctor may recommend that you take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin, others), to help ease painful menstrual cramps. However, if you find that taking the maximum dose doesn't provide full relief, you may need to try another treatment approach to manage your signs and symptoms.

Hormone therapy
Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. That's because the rise and fall of hormones during a woman's menstrual cycle causes endometrial implants to thicken, break down and bleed.

Hormonal therapies used to treat endometriosis include:

Hormonal contraceptives. Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Most women have lighter and shorter menstrual flow when they're using a hormonal contraceptive. Using hormonal contraceptives — especially continuous cycle regimens — can reduce or eliminate the pain of mild to moderate endometriosis.

Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs block the production of ovarian-stimulating hormones. This action prevents menstruation and dramatically lowers estrogen levels, causing endometrial implants to shrink. Gn-RH agonists and antagonists can force endometriosis into remission during the time of treatment and sometimes for months or years afterward. These drugs create an artificial menopause that can sometimes lead to troublesome side effects, such as hot flashes and vaginal dryness. Taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease such side effects. If Gn-RH agonists don't relieve your pain, it's unlikely that endometriosis is responsible for your symptoms.

Danazol. Another drug that blocks the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis, is danazol. In addition, it suppresses the growth of the endometrium. However, danazol may not be the first choice because it can cause unwanted side effects, such as acne and facial hair.

Medroxyprogesterone (Depo-Provera). This injectable drug is effective in halting menstruation and the growth of endometrial implants, thereby relieving the signs and symptoms of endometriosis. Its side effects can include weight gain, decreased bone production and depressed mood.

Aromatase inhibitors. Although not specifically approved for the treatment of endometriosis, studies suggest that aromatase inhibitors may significantly reduce endometriosis-related pain. Aromatase inhibitors work by blocking the conversion of hormones such as androstenedione and testosterone into estrogen and by blocking the production of estrogen from endometrial implants themselves. This deprives endometriosis of the estrogen it needs to grow. To reduce the risk of side effects, such as bone loss and follicular cysts, aromatase inhibitors must be taken in combination with a Gn-RH agonist or an oral estrogen-progestin contraceptive.
Hormonal therapies aren't a permanent fix for endometriosis. It's possible that you could experience a recurrence of your symptoms after stopping treatment.

Conservative surgery
If you have endometriosis and are trying to become pregnant, surgery to remove endometrial implants may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery.

Conservative surgery removes endometrial growths, scar tissue and adhesions without removing your reproductive organs. Your doctor may do this procedure laparoscopically or through traditional abdominal surgery in more extensive cases. In laparoscopic surgery, a slender viewing instrument (laparoscope) is inserted through a small incision near your navel. Guided by the laparoscope, your doctor inserts other instruments through another small incision to remove endometrial implants. Such instruments might include a laser, small surgical instruments or a cautery — an instrument that destroys tissue with heat.

Assisted reproductive technologies to help you become pregnant are sometimes preferable to conservative surgery, and doctors often suggest these approaches if conservative surgery is ineffective.

Hysterectomy
In severe cases of endometriosis, surgery to remove the uterus and cervix (total hysterectomy) as well as both ovaries may be the best treatment. Hysterectomy alone is not effective — the estrogen your ovaries produce can stimulate any remaining endometriosis and cause pain to persist. Surgery is typically considered a last resort, especially for women still in their reproductive years. You can't get pregnant after a hysterectomy