Oral contraceptives for pain associated with endometriosis
Editorial Group: Cochrane Menstrual Disorders and Subfertility Group
Published Online: 18 JUL 2007
Assessed as up-to-date: 16 MAY 2007
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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.
- Publication Status: Edited (no change to conclusions)
- Published Online: 18 JUL 2007
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.
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.
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.
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.
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).
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
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.
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。
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)。
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)。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。