I am 24 and have had endometriosis for six years. I underwent laparoscopic surgery a year ago, but it returned months later after I stopped the monthly Lupron injections. I tried Depo-Provera but had some complications with it. My OB-GYN now has me on the birth control pill Levlen 28 on a noncyclic basis (skipping the placebos and starting a new pack). Is this really a reasonable treatment? I am worried that not having a period at all is not healthy. I don't plan on having children for at least another two years.

--Suzy

Continuous use of oral contraceptives is a well-known treatment to suppress (not cure) endometriosis. Until the availability of GnRH agonists like Lupron and progestins like Depo-Provera, it was probably the most widely used treatment. Continuous means taking only the active pills for anywhere from four to 12 months at a time, without a break. Many women will not bleed at all the entire time they are taking the active pills, but some will experience breakthrough bleeding; this annoying bleeding can be treated by additional estrogen for several days, or just stopping the pills for a week in order to go ahead and have a period.

There is no problem at all with not having a period under these circumstances. The combination of estrogen and progestin in the pill causes the uterine lining to be thin, so there is not much, if anything, to shed. As I tell my patients, "It's okay to not have your period on the pill (or Depo-Provera), but it's not okay to not have your period on your own."