Hormonal contraception in women with endometriosis: a systematic review

Abstract

Objective: A systematic review was carried out of studies of women with endometriosis, to examine the evidence for efficacy of the use of hormonal contraception to improve disease-related pain and decrease postoperative risk of disease recurrence.

Methods: A search of the Medline/PubMed and Embase databases was performed to identify all published English language studies on hormonal contraceptive therapies (combined hormonal contraceptives [CHCs], combined oral contraceptives [COCs], progestin-only pills [POPs] and progestin-only contraceptives [POCs]) in women with a validated endometriosis diagnosis, in comparison with placebo, comparator therapies or other hormonal therapies. Main outcome measures were endometriosis-related pain (dysmenorrhoea, pelvic pain and dyspareunia), quality of life (QoL) and postoperative rate of disease recurrence during treatment.

Results: CHC and POC treatments were associated with clinically significant reductions in dysmenorrhoea, often accompanied by reductions in non-cyclical pelvic pain and dyspareunia and an improvement in QoL. Only two COC preparations (ethinylestradiol [EE]/norethisterone acetate [NETA] and a flexible EE/drospirenone regimen) demonstrated significantly increased efficacy compared with placebo. Only three studies found that the postoperative use of COCs (EE/NETA, EE/desogestrel and EE/gestodene) reduced the risk of disease recurrence. There was no evidence that POCs reduced the risk of disease recurrence.

Conclusions: CHCs and POCs are effective for the relief of endometriosis-related dysmenorrhoea, pelvic pain and dyspareunia, and improve QoL. Some COCs decreased the risk of disease recurrence after conservative surgery, but POCs did not. There is insufficient evidence, however, to reach definitive conclusions about the overall superiority of any particular hormonal contraceptive.

摘要

目的：对子宫内膜异位症女性的研究进行一项系统性的回顾, 以检验激素避孕在改善疾病相关疼痛、降低术后复发风险方面的有效性证据。

方法：用Medline/PubMed和Embase数据库搜索识别所有出版的关于确诊子宫内膜异位症女性的激素避孕治疗（复方激素避孕药[CHCs]、复方口服避孕药[COCs]、单纯孕激素制剂[POPs]及单孕激素避孕药[POCs]）的英文研究, 并与安慰剂、对照组或其他激素治疗组进行比较。主要观察指标为子宫内膜异位症相关疼痛（痛经、盆腔痛、腹痛）、生活质量(QoL)、治疗期间的术后复发率。

结果：CHC和POCs治疗与痛经的临床显著减少相关, 常伴有非周期性盆腔疼痛和腹痛的减少及生活质量的改善。只有两种的COC制剂（炔雌醇[EE]/炔诺酮[NETA]和可变的EE/屈螺酮方案）的疗效明显优于安慰剂组。仅有三项研究发现术后用COCs (EE/NETA、EE/屈螺酮、EE/孕二烯酮)可降低疾病复发的风险。没有证据表明POCs可以降低疾病复发的风险。

结论：CHCs和POCs能有效缓解子宫内膜异位症相关的痛经、盆腔痛和腹痛, 并且改善生活质量。部分COCs可降低保守手术后疾病复发的风险, 但POCs不能降低风险。但是没有足够的证据可以得出明确的关于任何一种激素避孕药的总体优势的结论。

Keywords:

• Contraceptive implant
• endometriosis
• hormonal contraception
• injectable contraceptive
• levonorgestrel-releasing intrauterine system
• medical therapy
• oral contraception
• patch
• progestin-only contraceptive
• vaginal ring

Disclosure statement

Giovanni Grandi M.D. has served as consultant and member of advisory boards for Bayer HealthCare and TEVA/Theramex. No potential conflicts of interest were reported by the other authors.