Relieving pain of endometriosis: comparison of treatments

Relieving pain of endometriosis: comparison of treatments – Tips from Other Journals

Barbara Apgar

Chronic severe pain associated with endometriosis is usually refractory to complete relief of symptoms and usually recurs when treatment is stopped. Oral contraceptive pills and danazol at very low doses have proved effective in providing temporary relief of symptoms. Vercellini and associates conducted an open-label, randomized trial comparing the efficacy and safety of depot medroxyprogesterone acetate (DMPA) versus an oral contraceptive combined with danazol in the long-term treatment of moderate to severe pelvic pain in women with endometriosis.

Eighty women with laparoscopically documented endometriosis and moderate or severe pelvic pain were randomized to treatment for one year with intramuscular DMPA (150 mg every three months) or an oral contraceptive (ethinyl estradiol, 0.02 ma, plus desogestrel, 0.15 ma) combined with oral danazol (50 mg per day for 21 days of each 28-day cycle). The women graded their response to therapy by a visual analog scale and a 1- to 3-point rating pain score.

A significant decrease was observed in all symptom scores of both study groups. The two regimens were equally effective in reducing deep dyspareunia and nonmenstrual pain. Reduction in pain at menstruation was significantly greater in the women allocated to receive DMPA after one year because of the high rate of amenorrhea in these women. All of the women treated with DMPA had absence of regular menses but continued to have irregular spotting and bleeding. Side effects were generally well tolerated by the majority of patients. Spotting, weight gain and bloating were the most common side effects in both study groups. The median time until return of regular menstrual flow in the women who discontinued DMPA after one year was seven months; the maximum delay was one year.

At the one-year assessment point, 72.5 percent of the women in the group receiving DMPA were satisfied with treatment, compared with 57.5 percent in the group receiving oral contraceptives plus danazol. Combining an oral contraceptive with danazol had no significant advantage. Although the combination was efficacious in reducing pain, it tended to be less satisfactory than DMPA.

The authors conclude that patients with endometriosis using DMPA may experience a significant long-term reduction of moderate to severe pain that must be balanced with increased menstrual irregularity and potential delay in resumption of ovulation. The safety profile and cost of DMPA compare favorably with other medical therapies for endometriosis and provide the patient with another option for the treatment of chronic pelvic pain associated with this condition.

Vercellini P, et al. Depot medroxyprogesterone acetate versus an oral contraceptive combined with very-low dose danazol for long-term treatment of pelvic pain associated with endometriosis. Am I Obstet Gynecol 1996;175:396-01.

COPYRIGHT 1997 American Academy of Family Physicians

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