PROGESTINS FOR SYMPTOMATIC ENDOMETRIOSIS - A CRITICAL ANALYSIS OF THEEVIDENCE

Objective: To obtain estimates of the effects of progestin treatment f or pelvic pain associated with endometriosis. Data Identification: Inf ormation from studies published in the English-language literature bet ween 1966 and 1996 was pooled. Articles were identified through hand a nd computerized searches using MEDLINE. Study Selection: A total of 27 trials that were published in peer-reviewed journals were identified, and 13 of these were excluded from the analysis because of methodolog ic limitations. Nine of the remaining 14 studies were noncomparative ( 8 prospective and 1 retrospective), 1 was quasi-randomized, and 4 were true randomized controlled trials. Data Extraction and Synthesis: The sample size was generally limited; the mean number of patients includ ed was 26 in the noncomparative trials and 29 in the randomized contro lled trials. The mean duration of treatment was 6 months. A total of 3 55 women had pain at entry. Considering all noncomparative studies, th e pooled frequency of nonresponders at the end of treatment was 9% (18 /203; 95% confidence interval [CI], 5.3% to 13.6%). The common odds ra tio from the four randomized controlled trials comparing progestins wi th danazol or a GnRH agonist was 1.1 (95% CI, 0.4 to 3.1), suggesting equivalence in treatment effect. In the only double-blind, placebo-con trolled trial, the frequency of nonresponders was not significantly di fferent in the two arms. Only four studies assessed pain after drug wi thdrawal. The pooled frequency of pelvic pain at the end of follow-up was 50% (35/70; 95% CI, 37.8% to 62.2%). The overall crude conception rate after therapy among women who desired pregnancy was 44% (86/194; 95% CI, 37.2% to 51.6%). Side effects of limited clinical relevance we re observed frequently. Conclusion(s): The available data suggest that the efficacy of progestins for temporary relief of endometriosis-asso ciated pelvic pain is good and comparable to that of other, less safe treatments. (C) 1997 by American Society for Reproductive Medicine.