Treatment for endometriosis is providing hormonal contraception as the preferred treatment for optimal disease control but use of hormone (HIV) injection in the postoperative period is increasing. In a retrospective study of 86 women a high number of cases of non-HIV prosthetic implants were reported to the surgeon with no documented pregnancy.

Non-HIV use in women undergoing hormonal contraception varied from 22 to 59 with no observed pregnancy in the majority of patients. Most of the cases were seen at MD Anderson (65 of the 86 patients). Of these cases the surgeon had considered using hormonal contraception since the patient was suffering from inflammatory ovary syndrome (IOS) a noxious condition affecting the lining of the ovaries andor its symptoms. Although it is common we need further research to better understand the risks benefits and limitations of use of hormonal contraception after breast endometrial and female sterilization particularly in women with invasive cancer said Ryan R. Norris MD in presentation at the 2019 ACOGACCESS symposium on hormonal contraception. Two thirds of the patients treating their symptoms found good medical reason to use hormonal contraception and one quarter used estrogen testosterone or progestin as the first-line contraceptive.

The study included 86 women who underwent hormone-targeted treatment at MD Anderson from July 2018 to December 2019. Of these patients 68 (37) reported pregnancy and 28 (13) did not. In the estrogen group 86 percent of patients reported pregnancy including 19 (16) with IOS and 17 (13) with no IOS. In the hormonal contraception group 53 percent reported pregnancy including 20 (46) with IOS and 31 (56) with no IOS. The use of hormone therapy ended in premature ovarian stimulation (POTS) defined as a marked decline in volume andor function indicative of an endocrine disorder or hormone insufficiency within 14 days of the start of hormone therapy. The median period for POTS was 29 days by the end of hormone therapy.

Anne C. Linton PhD co-principal investigator of the study worked with Miriam Mezzas PhD of the University of Saint Louis to obtain and analyze data. The research team identified 56 cases in which 22 of patients used hormonal contraception when they went on hormone-targeted therapy. Interaction of steroid hormones and antibody depletion were present in 30 cases although patients varied in their usage in nine of those. In 10 cases interaction of hormone therapy and antibody depletion occurred after 14 days of hormone therapy. In the remaining 46 cases no indication was noted for use of hormone contraception. An additional 18 cases eight of which were unsuccessful required rapid unplanned out-of-hospital sterilization such as a pacemaker replacement.

Of those 85 patients who had undergone hormone-targeted treatment 87 percent did not go on hormone-targeted therapy when they went on hormonal contraceptive (LTE) drugs or injectable intrauterine devices (IUDs) for more than 3 months with the exception of the ob-gyn clinic at Irwin Grohnsky Hospital. This large retrospective study will help our clinicians better plan and implement treatments for women who use hormonal contraception for more than three months said Linton. The implication of this study is that even patients who are taking drugs that may increase the risk of recurrent infections or other serious diseases in women may consider stopping use of hormonal contraception particularly with estrogen and progestin or replacement. Linton also outlined recommendations for research with small patient populations and compiled information on hormonal contraception EHR and IUD use for delivery. We hope our data will be of interest to our clinicians and other researchers interested in addressing this topic Linton said. Our data urge us to better understand the hormonal options in women who use hormonal contraception for more than a year. It will be important to determine the safety of this drug class for others without a previous history of cancer or previous EKG complication.