Volume 9, Issue 3 (7-2011)                   IJRM 2011, 9(3): 163-170 | Back to browse issues page

XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Wong W S F, Lim C E D. Hormonal treatment for endometriosis associated pelvic pain. IJRM 2011; 9 (3) :163-170
URL: http://ijrm.ir/article-1-237-en.html
1- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
2- South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia , celim@unswalumni.com
Abstract:   (2721 Views)
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.
Full-Text [PDF 365 kb]   (687 Downloads) |   |   Full-Text (HTML)  (412 Views)  
Type of Study: Original Article |

References
1. Alabama, B. Treatment of pelvic pain associated with endometriosis. Fertil Steril 2008; 90: 260-269. [DOI:10.1016/j.fertnstert.2008.08.057]
2. Vercellini P, Trespidi L, De Giorgo O, Cortesi I, Parazzini F, Crosignani PG. Endometriosis and pelvic pain: relation to disease stage and localization. Ferti Steril 1996; 65: 299-304. [DOI:10.1016/S0015-0282(16)58089-3]
3. Crosignani PG, Luciano A, Ray A, Bergqvist A. Subcutaneous depot medroxy-progesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain. Hum Reprod 2006; 21: 248-256. [DOI:10.1093/humrep/dei290]
4. Harada T, Momoeda M, Taketani Y, Aso T, Fukunaga M, Hagino H. et al. Dienogest is as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis-a randomized, double-blind, multicenter, controlled trial. Fertil Steril 2009; 91: 675-681. [DOI:10.1016/j.fertnstert.2007.12.080]
5. Kives S, Brown J, Prentice A, Deary A, Bland ES. Progestens and anti-progestagens for pain associated with endometriosis (review). Cochrane Database of Systematic Reviews. 2009; Issue 1.
6. MetaAnalyst. Accessed from https://research.tufts-nemc.org/metaanalyst/index.html Accessed on 19th Sep,
7. Kjaergard LL, Villumsen J, Gluud C. Reported methodological quality and discrepancies between large and small randomized trials in meta- analyses. Ann Intern Med 2001; 135: 982-989. [DOI:10.7326/0003-4819-135-11-200112040-00010]
8. Harada T, Momoeda M, Taketani Y, Hoshiai H, Terakawa N. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo- controlled, double-blind, randomized trial. Fertil Steril 2008; 90: 1583-1588. [DOI:10.1016/j.fertnstert.2007.08.051]
9. Petta CA, Ferriani RA, Abrao MS, Hassan D, Silva JCR, Podgaec S, et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum Reprod 2005; 20: 1993-1998. [DOI:10.1093/humrep/deh869]
10. Sesti F, Pietropolli A, Capozzolo T, Broccolo P, Pierangeli S, Bollea MR, et al. Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III-IV. A randomized comparative trial. Fertil Steril 2007; 88: 1541-1547. [DOI:10.1016/j.fertnstert.2007.01.053]
11. Walch K, Unfried G, Hubera J, Kurza C, Trotsenburgc MV, Pernickab E, et al. Implanon® versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis- a pilot study. Contraception 2008; 79: 29-34. [DOI:10.1016/j.contraception.2008.07.017]
12. Vercellini P, De Giorgo O, Oldani S, Cortesi LA, Panazza S, Crosignani PG. Depot medroxyprogesterone acetate versus an oral contraceptive combined with very- low, dose danazol for long-term treatment of pelvic pain associated with endometriosis. Am J Obstet Gynecol 1996; 175: 396-401. [DOI:10.1016/S0002-9378(96)70152-7]
13. Walch K., Unfried G, Huber J, Kurz C, Trotsenburg MV, Pernicka E et al. Implanon versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis- a pilot study. Contraception 2009; 79: 29-34. [DOI:10.1016/j.contraception.2008.07.017]
14. Langley GB, Sheppeard H. The visual analogue scale: Its use in pain measurement. Rheumatol Int 1985; 5: 145-148. [DOI:10.1007/BF00541514]
15. Langley GB, Sheppeard H. Problems associated with pain measurement: comparison of the visual analogue and verbal rating scales. Clin Exp Rheumatol 1984; 2: 231-234.

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Designed & Developed by : Yektaweb