DEPOT MEDROXYPROGESTERONE ACETATE VERSUS AN ORAL-CONTRACEPTIVE COMBINED WITH VERY-LOW-DOSE DANAZOL FOR LONG-TERM TREATMENT OF PELVIC PAIN ASSOCIATED WITH ENDOMETRIOSIS

OBJECTIVE: Our purpose was to evaluate the efficacy and safety of depo t medroxyprogesterone acetate versus an oral contraceptive combined wi th very-low-dose danazol in the long-term treatment of pelvic pain in women with endometriosis. STUDY DESIGN: Eighty patients with endometri osis and moderate or severe pelvic pain were randomized to treatment f or 1 year with intramuscular depot medroxyprogesterone acetate 150 mg every 3 months or a cyclic monophasic oral contraceptive (ethinyl estr adiol 0.02 mg, desogestrel 0.15 mg) combined with oral danazol 50 mg a day for 21 days of each 28-day cycle. The women were asked to grade t he degree of their satisfaction a; the end of therapy. Variations in s everity of symptoms during treatment were determined by a 10 cm Visual analog and a 0- to 3-point verbal rating scale. RESULTS: Twenty nine of 40 subjects (72.5%) in the depot medroxyprogesterone acetate group were satisfied after 1 year of therapy compared with 23 of 40 (57.5%) in the oral contraceptive plus danazol group (chi(2), = 1.37, rho = 0. 24, odds ratio 1.95, 95% confidence interval 0.76 to 4.97). A signific ant decrease was observed in all symptom scores in both study groups. At 1-year assessment dysmenorrhea was significantly greater in women a llocated to oral contraceptive plus danazol. CONCLUSION: Depot medroxy progesterone acetate seems to be an effective, safe, and convenient lo w-cost treatment for pelvic pain associated with endometriosis, Howeve r, women should be carefully counseled regarding menstrual changes and the potential prolonged delay in the return of ovulation.