Systemic HCG treatment in patients with endometriosis: A new perspective for a painful disease

Abstract

Endometriosis is characterized by the presence of endometrium-like tissue outside the uterus. This condition causes painful periods, chronic pelvic pain, subfertility and a profound reduction in quality of life, especially during women's reproductive years. Currently available medical therapies offer comparatively little therapeutic benefit and are often burdened by considerable side effects. However, since clinical evidence shows that pregnancy leads to alleviation of endometriotic symptoms, we have for the first time examined the effect of human chorionic gonadotrophin (HCG) injections on symptoms such as dysmenorrhea and pelvic pain. Thirty-one patients with histologically verified endometriosis refractory to therapy received 1 to 2 intramuscular injections of 1500 to 5000 IU HCG per week for a period of 3-12 months. A QoL questionnaire and the visual analog pain intensity scale (VAS) were used to evaluate quality of life and pain intensity, respectively, before and after three months of treatment. Three months of HCG therapy led to a highly significant reduction of endometriosis-related pain (p<0.001, Wilcoxon test) and to improvement of disease-related parameters such as sleeplessness (p<0.001), irritability (p<0.001), overall discomfort (p<0.001), depressive moods (p<0.001) and painful defecation (p=0.01). Dyspareunia and dysmenorrhea also clearly improved (both p<0.001), though HCG did not lead to significant reduction of dysuria (p=0.66). Prolonged therapy with HCG for up to 12 months (mean: 4.42 months) did not lead to reduction of the beneficial effect. HCG injections lead to significant and clinically relevant reduction in pain intensity and to greatly improved quality of life in women with therapy-refractory endometriosis. The remarkable clinical effect of parenteral HCG in our study will have to be confirmed in additional trials but clearly indicates an extremely promising new perspective in the treatment of endometriosis.