I have endometriosis. I have recently undergone surgery and Lupron injections (for six months) to treat the endo. My doctor has informed me I have a "window of opportunity" of 18-24 months to conceive. My husband and I have only been married for seven months and are not ready to try for children yet. The doctor also said that birth control pills would help keep the endo from coming back. How long will the birth control pills work to keep the endometriosis at bay before we have to start trying for a baby?

Cindy

The most effective management of endometriosis is to surgically remove (excise) all diseased tissue. This is not an easy task. Quite often, a physician will not have the necessary skill to remove all the endometriosis and prescribes a GnRH-agonist such as Lupron hoping it will make a difference. Unfortunately, Lupron does not make up for less-than-skilled surgery.

Lupron is best used to manage persistent pelvic pain related to endometriosis in women who do not wish to conceive. It is only effective while you are taking it. If the endometriosis has been incompletely treated at surgery, then as soon as you stop taking the Lupron shots, the pain will recur.

Another common myth is that using Lupron will help boost your fertility. Studies have shown repeatedly that there is no fertility benefit to taking Lupron for six months. The only effect is that you will be about $2,500 poorer and six months older. I am not really certain why this myth has continued, but it is about time that physicians fully understand the financial, physical and emotional costs of this type of fertility treatment.

Untreated, endometriosis will progress in about 60 percent of women. After deep excisional surgical treatment, recurrence rates at five years are 20-35 percent. If surgical treatment did not remove all the diseased tissue, the recurrence rates are higher and duration of surgical benefit may be minimal.

After complete resection of all endometriotic tissue, the birth control pill may be sufficient to keep the problem at bay. As Lupron is usually prescribed for a six-month period, its benefit will only be for six months. Lupron combined with add-back therapy can be used for a longer period of time, providing satisfactory control of pain for most women. The same is true for birth control pills. Unfortunately, there is no way to predict each individual's chance of recurrence or response to each type of medical therapy. I am aware of no side-by-side comparison trials of Lupron and birth control pills looking at time to recurrence after surgery.