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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
517
ic effects, such as changes in lipid profile, weight gain,
edema, acne, vaginal dryness, hot flashes, liver toxicity,
breast atrophy, voice alteration, hirsutism, and oily skin;
however, vaginal use has shown satisfactory results.
23
Ac-
cordingly, while indicating a drug for treatment of pain
associated with endometriosis, one must consider the ad-
verse effects and investigate the patient’s satisfaction with
the treatment. It is also recommended to inform women
with endometriosis of the benefits, limitations and costs
of each drug. In relation to dienogest (DNG), a scientif-
ic paper recently published presented the results of nine
studies using DNG, short and long term, in the treatment
of endometriosis. This drug proved to be effective in re-
ducing pain symptoms associated with endometriosis.
36
In addition to the clinical treatments that reduce es-
trogenic activity, as presented above, drugs that reduce
inflammation are also used in endometriosis (non-ste-
roidal anti-inflammatory drugs – NSAIDs). Two studies
have evaluated the combination of N-palmitoyl ethanol-
amine and transpolydatin/polydatin, drugs that act on
inflammation, in the treatment of pain associated with
endometriosis.
18,31
Polydatin is a resveratrol glycoside
that has antioxidant activities. Therefore, the combina-
tion of these drugs work on the inflammatory process-
es and oxidative stress involved in the development of
endometriosis.
The studies presented above show that the pharma-
cological and surgical treatments for relief of pain asso-
ciated with endometriosis are effective. Most clinical
treatments lead to stabilization or regression of lesions,
which usually recur after the medication is stopped, as
well as recurrence of the disease after surgery.
34
There
has been predominance in the use of medication to con-
trol the pain associated with endometriosis. This is in
the premise established by the American Society for Re-
productive Medicine (ASRM) which has established that
“endometriosis should be viewed as a chronic disease that
requires a life-long pain management plan with the goal
of maximizing the use of medical treatment and avoid-
ing repeated surgical procedures”.
37
Despite the side ef-
fects of drugs and their cost, surgery is an invasive pro-
cedure with a risk of complications. Thus, surgery is
indicated to confirm the diagnosis and to manage the
patients that do not respond to medical treatment.
34
Giv-
en the above, the choice of ideal treatment for endome-
triosis is complex. The data herein presented show that
both treatments helped to relieve the pain associated
with endometriosis and, consequently, they promoted
an improvement in the quality of life of women with this
gynecological disease.
C
onclusion
Endometriosis is a gynecological disease that has as its
main characteristic pain that compromises the sexual, so-
cial and professional life of women affected. Thus, pain-
ful symptoms have been linked to deterioration in the
quality of life of such patients. Treatment for this disease,
therefore, focuses on pain relief.
The data herein presented show that patients with
endometriosis exhibit high levels of pain. Surgery and
the use of drugs provided reduced pain scores in patients
with endometriosis, but nevertheless exhibit disadvan-
tages, such as risk of recurrence and side effects, respec-
tively. Treatment of endometriosis is, therefore, a chal-
lenge 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 ob-
tained with the use of conventional treatment.
R
esumo
Avaliação da dor associada à endometriose e influência
do tratamento convencional: uma revisão sistemática
A endometriose é uma doença ginecológica crônica ca-
racterizada por quadros álgicos constantes responsáveis
pela redução da qualidade de vida das portadoras. O tra-
tamento convencional, que inclui o cirúrgico e farmaco-
lógico, tem por finalidade reduzir os sintomas de dor. Este
estudo teve por objetivo avaliar os níveis de dor nas mu-
lheres com endometriose, com enfoque na influência do
tratamento convencional no controle dessa variável. Para
isso, foi realizada uma pesquisa bibliográfica no Medline/
PubMed e foram encontrados 119 artigos científicos, sen-
do que, após a aplicação dos critérios de inclusão e exclu-
são, 27 foram selecionados para leitura e elaboração des-
ta revisão. Desse modo, nove estudos avaliaram a
contribuição da cirurgia; dezessete, o uso de medicamen-
tos para redução nos níveis de dor em pacientes com en-
dometriose; e um, o tratamento cirúrgico e medicamen-
toso. Os principais resultados dessas pesquisas estão
apresentados e discutidos nesta revisão. A cirurgia e o uso
de medicamentos proporcionaram redução nos escores
de dor nas pacientes com endometriose, no entanto, exi-
bem desvantagens como risco de recorrência e efeitos co-
laterais, respectivamente. Assim, o tratamento para en-
dometriose é um desafio para ginecologistas e pacientes,
uma vez que é necessário selecionar a melhor abordagem
terapêutica para essa doença. Entretanto, melhora na qua-
lidade de vida das pacientes foi obtida com o emprego do
tratamento convencional.