Authors' objectives:

This report aims to collect present knowledge on treating endometriosis-linked pain.

Authors' recommendations: NSAIDs decrease menstrual pain linked to endometriosis. Among hormonal drugs, a continuous peroral daily dose of 100 mg medroxyprogesterone acetate reduces pain but produces quite many side effects. Progesterones are not effective as cyclical therapy. Contraceptive drugs decrease pain over short periods almost as well as gonadotropin releasing hormone agonists (GnRH-agonists). GnRH-agonists and danazole decrease pain, but patients often discontinue using these drugs due to side effects. Supplementary hormone therapy (add-back-therapy) decreases the side effects of GnRH-agonists while the effect on pain remains. Little data exist on the optimal dosage of GnRH-agonists. Although the NSAIDs and hormonal drugs suppress the pain caused by endometriosis, they have little effect on the progression of the disease. After discontinuing medication, the pain often returns rapidly. The surgical treatment of endometriosis removes pain, producing more lasting effects than drugs do. Laparoscopic removal of endometrial tissue is an effective treatment for pain related to stage I-II endometriosis. The surgical removal of endometriomas reduces pain; the most important factor is complete removal of endometrial tissue. Mere evacuation of an endometrioma always results in rapid recurrence. The removal of deep tissue colonies relieves pain and the effect may last for years. Surgical interruption of pelvic nerve pathways does not increase the effectiveness of surgery. The effect of hysterectomy or ovarectomy on endometriosis with pain has been studied little. The surgical treatment of endometriosis requires much experience. Not enough is known about the benefit of preoperative hormone therapy for pain caused by endometriosis. A postoperative six-month treatment with progestins, contraceptives, danazole or GnRH-agonists delays symptom recurrence. All Finnish hospitals with a department of gynecology treat endometriosis actively. The treatment patterns are otherwise quite similar, but approaches on extensive and rectovaginal endometriosis vary widely. Expert surgical treatment is not available to all patients with endometriosis. Surgery is a justified first choice in cases of severe endometriosis or intensive pain. After operation the postoperative medication can be prescribed for six months. When the disease seems to be mild and the patient does not have problematic pain, the first choice of treatment is hormonal therapy or nonsteroidal anti-inflammatory analgesics. Medication is selected individually, based on the patient's age and need for contraception etc. If the first line of treatment is ineffective, surgical interventions are considered. After treatments, it is useful to re-evaluate the situation and plan the follow-up.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://finohta.stakes.fi/FI/julkaisut/raportit/raportti19.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Finland

Organisation Name: Finnish Coordinating Center for Health Technology Assessment

Contact Address: Finnish Office for Health Care Technology Assessment (Finohta)

Contact Name: .

Contact Email: fincchta@ppshp.fi

Copyright: Finnish Office for Health Care Technology Assessment