Endometriosis: alternative methods of medical treatment

Figures & data

Table 1 Studies discussed in this publication

Drug	Study	Treatment	Main results	Side effects	Current status
GnRH antagonists	Diamond et al^Citation14	RCT elagolix 150 mg or 250 mg/day or placebo during 3 months	Elagolix improved dysmenorrhea and dyspareunia	Headache, nausea, anxiety, hot flashes Changes in BMD	Phase III RCT
Aromatase inhibitors	Soysal et al^Citation18	RCT anastrozole 1 mg/day with goserelin 3, 6 mg/4 weeks or goserelin alone for 6 months	Longer pain-free interval and lower recurrence rate with combination	Loss of BMD with combination, but not osteoporosis or osteopenia	Use of aromatase inhibitors associated to another hormonal treatment (oral contraceptive pills, progestogens or GnRH analog) recommended only in women in whom all surgical and medical treatments have failed
	Alborzi et al^Citation19	RCT letrozole 2, 5 mg/day or triptorelin 3, 75 mg/4 weeks or case control for 2 months	No differences in pregnancy rate and endometriosis recurrence	Not reported
	Roghaei et al^Citation20	RCT letrozole 2, 5 mg/day or danazol 600 mg/day or placebo for 6 months	Reduction in pain scores in treatment groups	Not reported
Aromatase inhibitors (continuation)	Ailawadi et al^Citation21	Open-label nonrandomized letrozole 2, 5 mg/day and norethindrone acetate 2, 5 mg/day for 6 months	Reduction in laparoscopically visible endometriotic lesions and pain scores	No changes in BMD Mild hot flashes, vaginal spotting, mood swings, and headaches
	Remorgida et al^Citation22	Open-label nonrandomized letrozole 2, 5 mg/day and norethindrone acetate 2, 5 mg/day for 6 months	Reduced pain symptoms	No changes in BMD Quick recurrence after treatment Weight gain, mood swings, weakness
	Ferrero et al^Citation23	Open-label nonrandomized letrozole 2, 5 mg/day and norethindrone acetate 2, 5 mg/day or norethindrone acetate alone for 6 months	Reduced pelvic pain and dyspareunia	No changes in BMD More frequent in letrozole group (bleeding, joint pain, myalgia, weight gain)
	Ferrero et al^Citation24	Open-label nonrandomized letrozole 2, 5 mg/day and norethindrone acetate 2, 5 mg/day for 6 months	Pain improvement, reduction in gastrointestinal symptoms
Aromatase inhibitors (continuation)	Amsterdam et al^Citation25	Open-label nonrandomized anastrozole 1 mg/day and ethinylestradiol 20 μg/day and levonorgestrel 0, 1 mg/day for 6 months	Reduction in pain scores	Headache, hot flashes, mood changes, muscle aches, and breakthrough bleeding No change in BMD
	Remorgida et al^Citation26	Open-label nonrandomized letrozole 2, 5 mg/day and desogestrel 75 μg/day for 6 months	Improvement in dysmenorrhea and dyspareunia	No changes in BMD Vaginal bleeding, weight gain, abdominal bloating Ovarian cysts with combination
	Hefler et al^Citation27	Anastrozole vaginal 0, 25 mg/day for 6 months	Improvement in dysmenorrhea No improvement in chronic pelvic pain	No change in BMD No severe adverse events
SPRMs	Kettel et al^Citation34,Citation35	Open clinical trial, mifepristone 50 mg/day for 6 months	Improvement in pelvic pain	Not significant	Need for more RCT Open-label study with ulipristal under recruitment RCT telapristone under recruitment (Phase II)
	Chwalisz et al^Citation36	RCT asoprisnil 5, 10 or 25 mg/day or placebo for 3 months	Reduced nonmenstrual pelvic pain and dysmenorrhea	Mild and self-limiting
Anti-TNF-α	Koninckx et al^Citation40	RCT infliximab 5 mg/kg or placebo 3 months prior to surgery	No differences in pain scores	Myalgia, mild infusion reaction, acute tonsillitis, leukemia	No important benefit effect Need for more RCT
Antiangiogenic factors
Cyclooxygenase 2 inhibitors	Machado et al^Citation63	RCT rofecoxib 25 mg/day or placebo for 6 months	Improvement in pelvic pain and dysmenorrhea	Not significant (not reported)	Rofecoxib has been withdrawal from the market (severe cardiovascular effects in long-term users)
Pentoxifylline	Kamencic and Thiel^Citation70	RCT pentoxifylline 800 mg/day or control group after surgery for 3 months	Improvement in pain at 2 and 3 months after surgery	Not reported	No current evidence for using pentoxifylline
	Alborzi et al^Citation71	RCT pentoxifylline 800 mg/day or placebo after surgery for 6 months	No differences in pregnancy rates and recurrence of symptoms	Not reported
	Balasch et al^Citation72	RCT pentoxifylline 800 mg/day or placebo for 12 months	No difference in pregnancy rates	Not reported
	Creus et al 73	RCT pentoxifylline 800 mg/day orplacebo for 6 months	No difference in pregnancyrates	Not reported

Abbreviations: RCT, randomized clinical trial; BMD, bone mineral density; GnRH, gonadotropin releasing hormone; SPRMs, selective progesterone receptor modulators; TNF, tumor necrosis factor.

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