Gonadotrophin-releasing hormone analogues for pain associated with endometriosis

Prentice, Andrew; Deary, Alison; Goldbeck‐Wood, Sandra; Farquhar, Cindy; Smith, S. K.

doi:10.1002/14651858.cd000346

Cited by 59 publications

(63 citation statements)

References 54 publications

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“…[7][8][9] Surgery for rectovaginal endometriosis can be complex and challenging and often involves a multidisciplinary team (MDT). The choice of surgery will depend to some extent on the reproductive plans of the women as well as the surgical skill available.…”

Section: Introductionmentioning

confidence: 99%

Urological and colorectal complications following surgery for rectovaginal endometriosis

Slack

Child

Lindsey

et al. 2007

BJOG

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Objectives To report the short-and medium-term complications of laparoscopic laser excisional surgery for rectovaginal endometriosis.Design Retrospective cohort study.Setting University teaching hospital, UK. Methods Women were identified from operative database, and a case note review was performed. Data for surgical outcome and surgical complications were collected.Main outcome measures Rates of urinary tract and colorectal complications.Results A total of 128 women underwent surgery. Of these, 32 required intraoperative closure of a rectal wall defect, including 3 segmental rectosigmoid resections. There were three rectovaginal fistulae and one ureterovaginal fistula. Ureteric damage occurred in two women, and five women suffered postoperative urinary retention. The risk of intraoperative bowel intervention was increased in women who complained of cyclical rectal bleeding.Conclusion Laparoscopic laser excision of rectovaginal endometriosis is a safe procedure with similar, if not lower, complication rates to other published surgical series.

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Section: Introductionmentioning

confidence: 99%

Urological and colorectal complications following surgery for rectovaginal endometriosis

Slack

Child

Lindsey

et al. 2007

BJOG

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“…For empiric medical therapy, OCPs and medroxyprogesterone acetate have apparent therapeutic equivalence and should be used as first-line therapies. [24][25][26] Many sources support the empiric use of GnRHas for treatment of the pain associated with endometriosis; 27 however, a systematic review found them to be no more effective than OCPs or progestogens 24 (online Table A). Furthermore, GnRHas can have hypoestrogenic side effects.…”

Section: Diagnostic Strategymentioning

confidence: 99%

“…28 These side effects may be alleviated somewhat with add-back therapy (i.e., replacement of hormones blocked by the action of GnRHas) without diminishing the effect of the GnRHa; however, the optimal method of add-back therapy has not been established. 27 One small study found the levonorgestrelreleasing intrauterine system (Mirena) to be effective in postoperative treatment for dysmenorrhea. 29 www …”

Section: Diagnostic Strategymentioning

confidence: 99%

Diagnosis and Management of Endometriosis

Kelley

Moravek

2016

Handbook of Gynecology

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“…The other problem associated with a 6-month course of GnRH-a is a reduction in vertebral bone mineral density (BMD) of approximately 3-4%. This concern has therefore limited its use to a 6-month duration [8,9]. In a multicentre randomised doubleblinded trial using a 12-month course of GnRH alone, women experienced a BMD loss in the lumber spine of 3.2% at 6 months and 6.3% at 12 months and com-plained of hot flashes, which were dramatically suppressed in the add-back HRT groups, whereas women receiving add-back HRT for 12 months had a significantly negligible (<1%) BMD loss [14].…”

Section: Gnrh-a Therapymentioning

confidence: 99%

“…Both have been shown to decrease symptoms when compared with placebo [6,7]. A large Cochrane metaanalysis of 26 randomised controlled trials confirmed GnRH-a to be effective in relieving pain [8,9]. However, long-term follow-up studies show a high recurrence rate following medical treatment [10,11].…”

Section: Introductionmentioning

confidence: 99%

Is helium thermal coagulator therapy for the treatment of women with minimal to moderate endometriosis cost-effective? A prospective randomised controlled trial

Lalchandani¹,

Baxter

Phillips

2005

Gynecol Surg

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This study compared the cost and time involved of helium thermal coagulator (HTC) treatment with medical therapy using gonadotrophin-releasing hormone analogues in women with minimal to moderate endometriosis. In a prospective randomised controlled trial, 35 women with history of pain were, upon confirmation of minimal to moderate endometriosis at diagnostic laparoscopy, randomised to immediate surgical or medical treatment. They were asked to complete analogue pain score sheets, and their symptoms were reviewed before treatment and at 3, 6, and 12 months after treatment. The cost of the medical or surgical treatment was evaluated from the time of diagnosis to the time of cure or symptom relief. The average cost per Helica probe is £111.81 with the machine on free loan, and the total cost of a 6-month course of injectable Zoladex with add-back therapy is £811.92. The costs involved in the two treatment modalities were analysed using the Mann-Whitney test; a p-value <0.05 was considered significant. In the medical group, three women out of 18 were symptom-free, 11 required surgical treatment of endometriosis, one had a laparoscopically-assisted vaginal hysterectomy, and three became pregnant before their final reviews. In the surgical group, nine women were symptom-free at the end of 12 months, four required Zoladex therapy, one required oral contraceptive pills, and three required repeat surgical treatment. The average cost per patient in the surgical arm was £323.29 and in the medical arm was £918.12 (p<0.0001). Mean operating times in the surgical and medical arms were 32.35 min and 20.83 min, respectively. This suggests that when facilities and expertise are available, it is better to see and treat mild to moderate endometriosis. There were no surgical complications in our series. Surgical treatment with HTC therapy is safe and is a cheaper and more effective therapy. This is the first study that has looked at the cost-effectiveness of HTC therapy in managing mild to moderate endometriosis.

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Gonadotrophin-releasing hormone analogues for pain associated with endometriosis

Cited by 59 publications

References 54 publications

Urological and colorectal complications following surgery for rectovaginal endometriosis

Urological and colorectal complications following surgery for rectovaginal endometriosis

Diagnosis and Management of Endometriosis

Is helium thermal coagulator therapy for the treatment of women with minimal to moderate endometriosis cost-effective? A prospective randomised controlled trial

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