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E
valuation
of
endometriosis
-
associated
pain
and
influence
of
conventional
treatment
:
a
systematic
review
R
ev
A
ssoc
M
ed
B
ras
2015; 61(6):507-518
507
REVIEW ARTICLE
Evaluation of endometriosis-associated pain and influence of
conventional treatment: a systematic review
A
lessandra
B
ernadete
T
rovó
de
M
arqui
1
1
PhD – Genetics, Universidade Estadual Paulista (Unesp), São José do Rio Preto, SP, Brazil. Associate Professor of Genetics at Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
S
ummary
Studed conducted at Universidade
Federal do Triângulo Mineiro (UFTM),
Uberaba, MG, Brazil
Article received:
5/15/2014
Accepted for publication:
9/23/2014
*Correspondence:
Address: Universidade Federal do
Triângulo Mineiro, Instituto de Ciências
Biológicas e Naturais, Campus I
Praça Manoel Terra, n. 330
Uberaba, MG – Brazil
Postal code: 38015-050
E-mail:
alessandratrovo@hotmail.com http://dx.doi.org/10.1590/1806-9282.61.06.507Financial support:
none
Conflict of interest:
none
Endometriosis is a chronic gynecological disease characterized by sustained
painful symptoms that are responsible for a decline in the quality of life of suf-
ferers. Conventional treatment includes surgical and pharmacological thera-
py aiming at reducing painful symptoms. This study aimed to evaluate pain
levels in women with endometriosis, focusing on the influence of convention-
al treatment in controlling this variable. To do so, a literature search was con-
ducted in the Medline/Pubmed databases, with 119 scientific articles found.
After applying the inclusion and exclusion criteria, 27 were selected for read-
ing and elaboration of this review. Thus, 9 studies evaluated the contribution
of surgery, 17 the use of drugs to reduce pain levels in patients with endome-
triosis and one assessed surgical and medical treatment. The main results of
these searches are presented and discussed in this revision. Surgery and the use
of drugs provided reduced pain scores in patients with endometriosis but never-
theless exhibit disadvantages, such as risk of recurrence and side effects, respec-
tively. Treatment of endometriosis is, therefore, a challenge for gynecologists
and patients, as they must select the best therapeutic approach for this disease.
However, improved quality of life in these patients has been obtained with the
use of conventional treatment.
Keywords:
endometriosis, pelvic pain, therapeutics, quality of life.
I
ntroduction
Endometriosis is a gynecological disease characterized by
the presence of endometrial tissue outside the uterine cavi-
ty.
1
Treatment consists in relieving chronic pelvic pain (CPP)
and recovering fertility, throughmedication and/or surgery.
2
Patients with endometriosis display the following types
of pain: CPP, dysmenorrhea, dyspareunia, dyschezia and
dysuria.
1
CPP is defined as non-menstrual or non-cyclical
pain, lasting at least six months, strong enough to inter-
fere with daily activities and requiring medical or surgical
treatment. Dysmenorrhea, also known as menstrual cramps,
is pelvic pain occurring before or during a menstrual peri-
od. Pain during intercourse is called dyspareunia and pain
when defecating and urinating are known as dyschezia and
dysuria, respectively.
As the disease and the pain are chronic conditions,
there is significant interference in the quality of life of
these women, in their professional performance, and sig-
nificant costs to health services.
Regarding professional activity, a multicenter study
showed that symptoms of endometriosis have a negative
impact on productivity at work, with the loss of approx-
imately one working day per week.
3
Another study showed
that 85% of patients with endometriosis perceived an ev-
ident decrease in the quality of their work, 19% reported
being unable to work due to pain and 69% of patients re-
ported that they continue to work despite the painful
sensation.
4
With respect to health expenditure, there is the need
for surgery for definitive diagnosis of the disease or even
to assess recurrences, as well as hospital admissions due
to pain. According to a multicenter study carried out by
Simoens et al.,
5
health care costs associated with endo-
metriosis were mainly due to surgery (29%), monitoring
tests (19%), hospitalization (18%) and medical appoint-
ments (16%). These high costs have been associated with
severity of the endometriosis, the presence of pelvic pain,
infertility, and a large number of years before diagnosis.
5