Medical and Surgical Therapies for Pain Associated with Endometriosis

Abstract

Endometriosis is a common condition for which a number of treatments have been proposed. Medical treatments are based on the hormonal responsiveness of endometriosis implants. These therapies include progestins (with or without estrogens), androgens, and gonadotropin-releasing hormone (GnRH) analogs. Surgical treatments may include hysterectomy with oophorectomy or organ-sparing surgery involving ablation or resection of visible lesions of endometriosis and restoration of pelvic anatomy. There are no studies that directly compare the effectiveness or adverse effects of medical therapy and surgical therapy. Studies on medical therapy compare different treatments with placebo or with other active treatments. Hormone-based therapies for endometriosis show 80%-100% effectiveness in relief of pelvic pain over a 6-month course of therapy. Serious adverse outcomes after medical therapy are unusual. Studies on surgical therapy are largely anecdotal, with noncomparative reports on a variety of surgical methods. A few comparative surgical studies have been reported. Because of the noncomparative nature of many of the surgical studies, the use of combinations of surgical procedures and techniques in the reported studies, and the reporting of results from surgeons with an unusually high level of technical skill, the gynecological practitioner has little basis in the literature for assessing the optimum surgical approach. Surgical complications are believed to be underreported and may be related to how aggressive a surgical procedure is undertaken.

Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial

“…Consistent with observations in the current trial, GnRH agonists such as LA are associated with hypoestrogenic effects and related adverse effects on BMD (Winkel and Scialli, 2001), which limits treatment to 6 months in the absence of add-back therapy. The European Society for Human Reproduction and Embryology (ESHRE) guideline recommends, in particular, careful consideration in the use of GnRH agonists in younger women who have not reached maximum bone density (Kennedy et al, 2005).…”

“…For example, GnRH agonists such as leuprolide acetate (LA), whereas accepted as highly efficacious therapy, are associated with symptoms of estrogen deprivation (including hot flushes, vaginal dryness, headache and decreased libido) and bone demineralization that limits treatment to 6 months in the absence of add-back therapy (Prentice et al, 2000;Winkel and Scialli, 2001;Mounsey et al, 2006). Danazol is characterized by adverse changes in lipid metabolism and androgenic adverse effects, including weight gain, oedema, acne, hirsutism and oily skin, which lead to low compliance with therapy (Winkel and Scialli, 2001;Selak et al, 2007).…”

Adolescent endometriosis

“…When severe dysmenorrhea is the primary complaint, continuous COCs may induce amenorrhea and subsequent relief of symptoms. 15 This therapy is only suppressive and not curative. Symptom recurrence was common after stopping therapy for 6 months.…”

Green Tea for Endometriosis

“…However, there are side effects, which include irregular menstrual cycle, sore breasts, headache, nausea, dizziness and bloating. These side effects are not usually serious and longlasting (Winkel et al, 2001), however many patients still feel unpleasant and difficult to cope with. Hence, most women could seldom complete this type of treatment.…”

“…Typically surgery becomes a choice after expectant management and hormonal therapy failed to reduce the patient symptoms (Olive et al, 2001;Winkel et al, 2001). Likewise, when anatomic distortions due to endometrial growths are present, surgery would also be the primary choice for treatment (Surrey et al, 2003).…”