Reevaluating response and failure of medical treatment of endometriosis: a systematic review

Abstract

ObjectiveTo assess patient response rates to medical therapies used to treat endometriosis-associated pain.DesignA systematic review with the use of Medline and Embase.SettingNot applicable.Patient(s)Women receiving medical therapy to treat endometriosis.Interventions(s)None.Main Outcome Measure(s)The proportions of patients who: experienced no reduction in endometriosis-associated pain symptoms; had pain symptoms remaining at the end of the treatment period; had pain recurrence after treatment cessation; experienced an increase or no change in disease score during the study; were satisfied with treatment; and discontinued therapy owing to adverse events or lack of efficacy. The change in pain symptom severity experienced during and after treatment, as measured on the visual analog scale, was also assessed.Result(s)In total, 58 articles describing 125 treatment arms met the inclusion criteria. Data for the response of endometriosis-associated pain symptoms to treatment were presented in only 29 articles. The median proportions of women with no reduction in pain were 11%–19%; at the end of treatment, 5%–59% had pain remaining; and after follow-up, 17%–34% had experienced recurrence of pain symptoms after treatment cessation. After median study durations of 2–24 months, the median discontinuation rates due to adverse events or lack of efficacy were 5%–16%.Conclusion(s)Few studies of medical therapies for endometriosis report outcomes that are relevant to patients, and many women gain only limited or intermittent benefit from treatment.

Systematic review and meta‐analysis of complementary treatments for women with symptomatic endometriosis

“…Approximately 30% of women still experience pain in endometriosis in spite of clinical and surgical interventions, indicating that 2 million women are affected by pelvic pain worldwide . Despite the high success rate of many treatments, this number is considerable.…”

“…Additionally, what can be concluded from the RCTs and the effectiveness of the treatments is unclear. Owing to heterogeneity among the studies included in the present review (exercises, yoga, electrotherapy, and acupuncture), only a simple meta-analysis incorporating two studies was possible.Approximately 30% of women still experience pain in endometriosis in spite of clinical and surgical interventions, indicating that 2 million women are affected by pelvic pain worldwide 28. Despite the high success rate of many treatments, this number is considerable.…”

Comparative analysis of molecular signatures suggests the use of gabapentin for the management of endometriosis-associated pain

“…Current endometriosis therapies present limited efficacy, high rates of symptom recurrence, and significant side-effects (3,4). For example the use of GnRH agonists is associated to side effects such as menopausal symptoms and reduced bone mineral density (21) which restrict their use and demand add-back therapy (22).…”

“…Endometriosis is generally treated by either surgical intervention, by analgesic treatment or by hormonal treatment suppressing cyclic ovarian hormone production and reducing or eliminating menses (2). Current therapies present, however, limited efficacy on endometriosis pain, high rates of symptom recurrence, and significant side-effects (3,4).…”

IL-1β Stimulates Brain-Derived Neurotrophic Factor Production in Eutopic Endometriosis Stromal Cell Cultures

“…4 The pathogenetic mechanisms that link endometriosis and pelvic pain remain unclear, although their association is clinically well established. 5,6 A prevailing immunocentric theory attributes inflammation through the recruitment of macrophages and other activated leukocytes from bone marrow to the endometriotic lesions by chemokines synthesized in situ. 7e9 One of the postulated consequences of immune cell activation in the endometriosis microenvironment is the elaboration of cytokines, growth factors, and eicosanoids that simultaneously stimulate lesion innervation and neovascularization through a coordinated mechanism that was coined neuroangiogenesis.…”