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Birth Control Pills

Some studies suggest that up to 70 percent of cases of chronic pelvic pain (CPP) in women of childbearing age may be associated with endometriosis. Endometriosis may be a significant factor even when endometrial growths are not large enough to be seen during a laparoscopic exam. Birth control pills are often used to help control endometriosis and fibroids, and may be helpful in some cases of pelvic pain.

GnRH Agonists

When birth control pills are not effective, more powerful drugs, called gonadotropin-releasing hormone (GnRH) agonists, are also used to treat endometriosis and shrink fibroids. These drugs decrease the amount of estrogen a woman produces, prevent ovulation and cause an artificial menopause. They cause symptoms similar to menopause and can also cause bone mineral loss, which can eventually lead to osteoporosis. For these reasons, GnRH agonists are typically used on a short-term basis, to relieve symptoms until other approaches can take effect.

Medroxyprogesterone Acetate

Other conditions that cause CPP, particularly pelvic congestion, appear to be associated with hormonal imbalances. High levels of estrogen produced by the ovaries seem to be associated with varicose veins in the pelvis (pelvic congestion). Women with pelvic congestion often have other signs of hormonal imbalance, such as heavy and painful periods and ovarian changes. One way to treat this problem is by balancing estrogen levels with progesterone. For this reason, medroxyprogesterone acetate is sometimes used to treat pelvic congestion.

Medroxyprogesterone acetate is the same substance used in the hormonal birth control method Depo-Provera. When used to treat CPP, it is taken orally, at doses considerably higher than those used for birth control. It prevents ovulation so you will not be able to take it if you wish to become pregnant. Other symptoms of this treatment are similar to those for Depo-Provera, but they tend to be more severe due to the high doses involved. Side effects include irregular periods (many women have no period after six to 12 months), weight gain, headaches, breast tenderness, bloating, depression, hair loss and loss of bone density.


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