Clinical management

COC or long-acting progestogen after endometriosis surgery?

A randomised controlled trial evaluated the effectiveness of long-acting progestogens (depot medroxyprogesterone acetate—DMPA, or the levonorgestrel releasing intrauterine system—LNG-IUS), versus the combined oral contraceptive pill (COCP), in preventing recurrence of endometriosis related pain after conservative surgery for endometriosis.
405 women were randomised to receive a long-acting progestogen (n=205) or combined oral contraceptive pill (n=200).
At three years, there was no difference in pain scores between the groups (both had improved by around 40% compared with preoperative values).
Women randomised to a long-acting progestogen underwent fewer surgical procedures or second line treatments compared with those randomised to the COCP group (73 v 97; HR: 0.67, 95% CI 0.44 to 1.00).

Advise patients seeking contraception after endometriosis surgery that there is a reduced risk of repeat surgery for endometriosis/ hysterectomy when taking long-acting progestogens compared to the COCP.
Share this research with your team members (e.g., practice nurses) who perform contraceptive reviews.

Read more about the research informing this GEM: https://doi.org/10.1136/bmj-2023-079006