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2015; 61(6):507-518
TABLE 3
Main results of 17 studies that evaluated the effect of drugs on pain scores.
Study
Sample
Medication
used
Number of patients
treated
Information regarding pain
(instrument used, types of
pain, etc.)
Main results and/or conclusion
Miller
6
120 women
with
endometriosis
Leuprolide
acetate
60 control group (treated with placebo)
60 treatment group (leuprolide acetate)
Double-blind study
VAS (pain levels measured
before the start of the study, 2
and 4 weeks after treatment)
Compared with the control women treated with a placebo, those treated with
GnRHa exhibited a statistically (p <0.0001) and clinically significant increase in
pain levels, showing that this therapy is associated with an increase in pain asso-
ciated with endometriosis.
Petta
et al.
10
82 women
with
endometriosis
LNG-IUS
GnRHa
Final sample: 71
34 – LNG-IUS
37 – GnRHa
VAS (pain levels measured
before and during the 6
months of treatment)
CPP decreased from the first month and continued to decline over the six
months with the two forms of treatment, with no difference between groups
(p>0.999). In both groups, the women with stage III and IV endometriosis
showed a faster improvement in VAS pain scores than those at stages I and
II (p <0.002).
Both treatments were effective in reducing the CPP associated with endometriosis.
The advantage of LNG-IUS is that it requires a single medical intervention for in-
sertion into the womb every five years andmay be the treatment of choice for wom-
en who do not want to become pregnant.
Remorgida
et al.
12
12 women
with
recto-vaginal
endometriosis
Letrozole
Norethis-
terone
acetate
Letrozole and norethisterone acetate
for 6 months
VAS (dysmenorrhea, deep
dyspareunia and CPP). Pain
symptoms were measured
before starting the treatment,
each month during treatment
(6 months) and 3, 6 and 12
months after completion of
treatment (follow-up)
100% of women with dysmenorrhea; 83.3% with deep dyspareunia and 83.3%
with CPP.
After completion of treatment, all symptoms of pain were significantly less in-
tense than baseline (dysmenorrhea: 8.8±1.0
versus
3.7±2.2; dyspareunia: 7.6±1.5
versus
2.2±2.0 and CPP: 5.6±0.9
versus
2.4±1.6). Symptoms of pain returned rap-
idly after 3 months of follow-up and, after six months, no significant difference
was observed in the intensity of dysmenorrhea, deep dyspareunia, and CPP com-
pared to baseline values.
Side effects reported by patients: weight gain (n=4), mood changes (n=4),
weakness (n=3), bone and joint pain (n=3), vaginal bleeding (n=2), muscle
pains (n=2), headache (n=2), depression (n=2), hot flashes (n=1), nausea
(n=1), decreased libido (n=1).
Due to the persistence of symptoms of pain, 41.7% of patients underwent sur-
gery after an average (± standard deviation) of 7 (± 2.5) months after the end of
medical treatment, that is, 5 patients had surgery during the follow-up.
The combined use of letrozoleand norethisterone acetate quickly and effective-
ly reduces the intensity of the symptoms of pain caused by recto-vaginal endo-
metriosis without significant side effects, though pain symptoms returned quick-
ly after stopping treatment.
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