Intervention Review

Oral contraceptives for pain associated with endometriosis

  1. Lucy-Jane Davis1,*,
  2. Stephen S Kennedy2,
  3. Jane Moore3,
  4. Andrew Prentice4

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 16 MAY 2007

DOI: 10.1002/14651858.CD001019.pub2

How to Cite

Davis LJ, Kennedy SS, Moore J, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD001019. DOI: 10.1002/14651858.CD001019.pub2.

Author Information

  1. 1

    Derriford Hospital, Peninsula Foundation Deanery, Plymouth, UK

  2. 2

    University of Oxford, Nuffield Department of Obstetrics and Gynaecology, Oxford, UK

  3. 3

    John Radcliffe Hospital, Nuffield Dept of Obstetrics & Gynaecology, Oxford, UK

  4. 4

    Rosie Maternity Hospital, Department of Obstetrics and Gynaecology, Cambridge, UK

*Lucy-Jane Davis, Peninsula Foundation Deanery, Derriford Hospital, 36 Elm Road, Mannamead, Plymouth, UK. ljd_456@yahoo.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Endometriosis is a common gynaecological condition which affects many women of reproductive age worldwide and is a major cause of pain and infertility. The modern oral contraceptive pill is widely used to treat pain occurring as a result of endometriosis, although the evidence for its efficacy is limited.

Objectives

To assess the effects of the oral contraceptive pill (OCP) in comparison to other treatments for painful symptoms of endometriosis in women of reproductive age.

Search methods

We searched the Menstrual Disorders and Subfertility Group Specialised Register of controlled trials; Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2006); MEDLINE (January 1966 to September 2006); EMBASE (1980 to September 2006); National Research Register; and reference lists of articles.

Selection criteria

All truly randomised controlled trials of the use of oral contraceptive pills in the treatment of women of reproductive age with symptoms ascribed to the diagnosis of endometriosis and made visually at surgical procedure were included.

Data collection and analysis

Study quality assessment and data extraction were carried out independently by two review authors. One of the assessors was an expert in the content matter. We contacted study authors for additional information.

Main results

Only one study met the inclusion criteria, in which a total of 57 women were allocated to two groups to compare an OCP to a GnRH analogue. Methods of randomisation and allocation concealment were unclear and the study was acknowledged by its authors to be underpowered. Women in the GnRH analogue group became amenorrhoeic during the treatment period of six months, whilst women in the OCP group reported a decrease in dysmenorrhoea. No evidence of a significant difference between the two groups was observed in terms of dysmenorrhoea at six months follow up after stopping treatment (OR 0.48; 95% CI 0.08 to 2.90). Some evidence for a decrease in dyspareunia was found at the end of treatment in women in the GnRH analogue group, although no evidence of a significant difference in dyspareunia was observed at the end of the six months follow up (OR 4.87; 95% CI 0.96 to 24.65).

Authors' conclusions

The limited data we found available suggests that this is no evidence of a difference in outcomes between the oral contraceptive pill (OCP) studied and GnRH analogue was as effective as a GnRH analogue in treating for endometriosis-associated painful symptoms of endometriosis. However, the lack of studies with larger sample sizes, or focusing on other comparable treatments is concerning and further research is needed to fully evaluate fully the role of OCPs oral contraceptive pills in managing symptoms associated with endometriosis.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Modern combined oral contraceptives for treatment of pain associated with endometriosis

Endometriosis is a common women's healthcare condition which is defined as the growth of endometrium (lining of the uterus) at sites outside the uterus, such as the ovaries. Endometriosis is commonly found in women with painful periods, pain with sexual intercourse, pelvic pain and infertility. Hormonal treatments, including the oral contraceptive pill (OCP) and gonadotrophin releasing hormone (GnRH) analogues are used to relieve the pain symptoms associated with endometriosis. There is some evidence to suggest that such treatments may also treat the actual deposits of endometriosis. However, many of the hormonal treatments have side effects which limit their acceptability and duration of use. Surgery may also be used to remove the deposits.

This review searched for studies which compared an OCP with other treatments. One small study (57 women) was found which compared an OCP to goserelin (a GnRH analogue) in two separate treatment groups. The study showed that the two treatments relieved endometriosis-associated pain equally well. The goserelin treatment stopped women from having periods. Clearly, therefore, these women did not report having pain with their periods during treatment. Goserelin can also only be safely taken for six months.
More women in the goserelin group had side effects of hot flushes, insomnia and vaginal dryness, whereas more women in the OCP group suffered headaches and weight gain. After six months follow up there were no differences between the groups. The methodology of the study was not rated highly by the review authors.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

治療子宮內膜異位症疼痛的最新口服複方避孕藥

子宮內膜異位症(Endometriosis)是一種常見的婦科疾病,影響全世界許多育齡婦女,同時也是引起疼痛和不孕症的主要原因。最新的口服避孕藥被廣泛用來治療由子宮內膜異位症引發的疼痛,然而其治療效力的證據仍然有限的。

目標

為了評估口服避孕藥(OCP),相較於其他療法,對育齡婦女子宮內膜異位症疼痛的治療效果。

搜尋策略

我們搜尋了Menstrual Disorders and Subfertility Group Specialised Register of controlled trials; Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2006); MEDLINE (January 1966 to September 2006); EMBASE (1980 to Septembe 006); National Research Register 以及研究報告的參考文獻清單。

選擇標準

由手術過程證實的子宮內膜異位症引起症狀的育齡婦女,收錄所有使用口服避孕藥治療的隨機對照試驗(randomised controlled trials;RCT)。

資料收集與分析

研究品質評估和數據提取分別由兩位獨立評論作者完成。其中一位評審是這領域的專家。我們接觸所收錄試驗的作者們以獲得更多的資料。

主要結論

只有一個研究符合納入標準,共有57名婦女被分配到兩組,比較OCP及GnRH類似物的治療效果。隨機分派和分配隱藏方法都不清楚,研究作者們承認本研究的檢定力(power)不足。GnRH類似物組的婦女在為期6個月治療期間內都無月經,而OCP組婦女月經失調(dysmenorrhoe 情形則減少。兩組在停止治療後6個月追蹤期間內,就月經失調而言,沒有顯著差異(O .48; 95 % CI為0.08至2.90)。GnRH類似物組婦女在治療結束時,有證據顯示較少發生性交疼痛(dyspareunia 。但兩組在停止治療後6個月追蹤期間內,就性交疼痛而言,沒有顯著差異(O .87; 95 % CI為0.96至24.65)。

作者結論

我們能找到有限的資料建議,口服避孕藥(OCP)的治療結果和GnRH類似物間並無顯著不同,口服避孕藥與GnRH類似物在治療子宮內膜異位症相關的疼痛一樣有效。然而,由於缺乏較大樣本數或針對其他可比較的治療方法的研究,需要進一步的研究來全面性評估口服避孕藥(OCP)在處理子宮內膜異位症相關症狀的角色。

翻譯人

本摘要由高雄醫學大學附設醫院蘇富敏翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

最新的口服避孕藥治療子宮內膜異位症相關的疼痛,子宮內膜異位症是一種常見的婦女健康照護問題,它的定義是子宮內膜在子宮外生長,例如生長在卵巢。子宮內膜異位症常見於痛期的婦女,性交疼痛的婦女,骨盆腔疼痛和不孕症的婦女。激素治療(Hormonal treatments),包括口服避孕藥(OCP)和促性腺釋放激素(GnRH)類似物,用來緩解子宮內膜異位症疼痛的症狀。一些證據顯示,這種療法還可以治療子宮內膜異位症。然而,許多激素治療具有副作用,限制了他們的接受程度和持續使用時間。手術也可移除異位的子宮內膜,本綜論搜尋比較口服避孕藥與其他治療方法的研究。一個比較分別接受OCP和goserelin(GnRH類似物)治療的小樣本研究(共57位婦女)發現,這兩種治療方法解除子宮內膜異位症相關的疼痛一樣有效。goserelin治療婦女會造成無月經。因此,這些婦女很明顯的在治療期間,不會有經痛。Goserelin只能安全地服用6個月,goserelin治療組有較多的婦女產生副作用,例如熱潮紅,失眠及陰道乾燥,而在OCP組則有較多的婦女,感受頭痛和體重增加。在治療結束後6個月的追蹤,這兩組之間並沒有差異。審查作者對研究的方法評價並不高。