International Journal of Reproductive Medicine
Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences of Yazd
Vol. 9, No. 3, 2011, pp. 163-170
Bioline Code: rm11025
Full paper language: English
Document type: Review Article
Document available free of charge
International Journal of Reproductive Medicine, Vol. 9, No. 3, 2011, pp. 163-170
© Copyright 2011 Iranian Journal of Reproductive Medicine.
Hormonal treatment for endometriosis associated pelvic pain|
Wong, Wu Shun Felix & Lim, Chi Eung Danforn
Background: Endometriosis is a common gynecological problem associated with chronic pelvic pain.
Objective: To evaluate the effectiveness of current hormonal treatments of endometriosis associated pain.
Materials and Methods: Randomized Controlled studies identified from databases of Medline and Cochrane Systemic Review groups were pooled. 7 RCTs were recruited for evaluation in this review. Data from these studies were pooled and meta-analysis was performed in three comparison groups: 1) Progestogen versus GnRHa; 2) Implanon versus Progestogen (injection); 3) Combined oral contraceptive pills versus placebo and progestogen. Response to treatment was measured as a reduction in pain score. Pain improvement was defined as improvement ≥1 at the end of treatment.
Results: There was no significant difference between treatment groups of progestogen and GnRHa (RR: 0.036; CI:-0.030-0.102) for relieving endometriosis associated pelvic pain. Long acting progestogen (Implanon) and Mirena are not inferior to GnRHa and depot medroxy progesterone acetate (DMPA) (RR: 0.006; CI:-0.142-0.162). Combined oral contraceptive pills demonstrated effective treatment of relieving endometriosis associated pelvic pain when compared with placebo groups (RR:0.321CI-0.066-0.707). Progestogen was more effective than combined oral contraceptive pills in controlling dysmenorrhea (RR:-0.160; CI:-0.386-0.066), however, progestogen is associated with more side effects like spotting and bloating than the combined contraceptive pills.
Conclusion: Combined oral contraceptive pills (COCP), GnRHa and progestogens are equally effective in relieving endometriosis associated pelvic pain. COCP and progestogens are relatively cheap and more suitable for long-term use as compared to GnRHa. Long-term RCT of medicated contraceptive devices like Mirena and Implanon are required to evaluate their long-term effects on relieving the endometriosis associated pelvic pain.
Endometriosis associated pelvic pain, Medical treatments, Progestogen, Combined oral contraceptive pills, GnRH
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