Hormonal treatment for endometriosis associated pelvic pain

Background: endometriosis is a common gynecological problem associated with chronic pelvic pain.objective: to evaluate the effectiveness of current hormonal treatments of endometriosis associated pain.materials and methods: randomized controlled studies identified from databases of medline and cochrane systemic review groups were pooled. 7 rcts were recruited for evaluation in this review. data from these studies were pooled and meta-analysis was performed in three comparison groups: 1) progestogen versus gnrha; 2) implanon versus progestogen (injection); 3) combined oral contraceptive pills versus placebo and progestogen. response to treatment was measured as a reduction in pain score. pain improvement was defined as improvement ≥1 at the end of treatment.results: there was no significant difference between treatment groups of progestogen and gnrha (rr: 0.036; ci:-0.030-0.102) for relieving endometriosis associated pelvic pain. long acting progestogen (implanon) and mirena are not inferior to gnrha and depot medroxy progesterone acetate (dmpa) (rr: 0.006; ci:-0.142-0.162). combined oral contraceptive pills demonstrated effective treatment of relieving endometriosis associated pelvic pain when compared with placebo groups (rr:0.321ci-0.066-0.707). progestogen was more effective than combined oral contraceptive pills in controlling dysmenorrhea (rr:-0.160; ci:-0.386-0.066), however, progestogen is associated with more side effects like spotting and bloating than the combined contraceptive pills.conclusion: combined oral contraceptive pills (cocp), gnrha and progestogens are equally effective in relieving endometriosis associated pelvic pain. cocp and progestogens are relatively cheap and more suitable for long-term use as compared to gnrha. long-term rct of medicated contraceptive devices like mirena and implanon are required to evaluate their long-term effects on relieving the endometriosis associated pelvic pain.