Management Of Endometriosis-related Pain Research Articles

Long-term treatment of endometriosis-related pain among women seeking hormonal contraception

Objective To evaluate the different effects of a progestin-only contraceptive with desogestrel (DSG) vs combined oral contraceptives (COCs) for a first line long-term treatment of endometriosis-related pain among patients seeking hormonal contraception. Methods An observational retrospective cohort study was conducted in collaboration with a local outpatient clinic for endometriosis among a group of nulliparous young women (n = 216) with endometriosis-related pain and seeking contraception. The cohort was subdivided into a group (n = 73) treated as first line by DSG and another group (n = 75) treated by a COC. During the study, clinical symptoms, side effects and possible changes in OC type use were recorded. Results No significant difference was found between the two groups in terms of clinical characteristics and pain scores before treatment. After 6 months both treatments were effective in reducing endometriosis-related pain, and those treated with DSG showed lower levels of dysmenorrhea, dyspareunia and nonmenstrual pelvic pain than COCs group (p < .01). After 12 months, in DSG Group some patients (15%) switched from DSG to a COC for breakthrough bleeding, whereas in COC Group 48% of patients switched to another type of COC for reduced efficacy on pain and/or for side effects. After 3 years of OC treatment, in DSG Group 79% of patients maintained the same therapy, whereas in COC Group only 14% continued the same COC type, 37% switched to another COC and 47% to DSG. Conclusions A progestin-only contraceptive with DSG is a valid option for long term management of endometriosis-related pain in patients seeking hormonal contraception.

Medical management of endometriosis: what the radiologist needs to know.

The role of the radiologist in the diagnosis and management of patients with endometriosis is increasing. Improvement in MRI imaging techniques has improved detection rate of subtle manifestations of endometriosis by radiologists. Therefore, the role of imaging in the diagnosis and follow-up after treatment is also likely to increase. Knowledge of new medical management pathways used in treating patients with endometriosis-related pain is important. The knowledge of various medication regimens will allow radiologists to continue to evaluate baseline disease, and to potentially assess for imaging response/stability to these medications. This article will review the current medical therapies in use in the management of endometriosis-related pain and describe potential imaging-related findings expected with these therapies.

64: Stepwise approach to the medical and surgical management of endometriosis related pain: A cost-effectiveness analysis

Endometriosis is a prevalent disease associated with significant cost; over $49 billion in medical costs is spent annually in the United States (US) alone. Limited data exist on the cost-effectiveness of various clinical regimens to guide management. We sought to determine which sequence of therapies would be most cost-effective for the treatment of endometriosis-related pain. We built a cost-effectiveness model using TreeAge Pro software to compare four distinct, stepwise strategies in the management of endometriosis-related pain (Figure 1). We compared: (Strategy 1) nonsteroidal anti-inflammatory drugs (NSAIDs) followed by surgery; (Strategy 2) NSAIDs, then short acting reversible contraceptives (SARCs) or long acting reversible contraceptives (LARCs) followed by surgery; (Strategy 3) NSAIDs, then SARCs/LARCs, then gonadotropin releasing hormone (GnRH) agonists or GnRH antagonists followed by surgery; (Strategy 4) proceeding directly to surgery. Probabilities, utilities, and costs were derived from the literature. We adopted the societal perspective and modeled outcomes over three years. Our primary outcome was the incremental cost-effectiveness ratio (ICER). Secondary outcomes included costs and quality-adjusted-life-years (QALYs). Cohort size was based on the approximate number of women aged 18-45 with dysmenorrhea and/or cyclic pelvic pain in the US. Univariate sensitivity analysis was performed on all model inputs. A tornado diagram was made to identify which variables had the greatest influence on the model. Among a theoretical cohort of 10,018,400 women, all four strategies were cost-effective at a standard willingness to pay threshold of 100,000 per QALY gained (Table 1). Strategy 2 was associated with the lowest cost per QALY gained (ICER of $803). If all women received a trial of GnRH agonist after failing hormonal contraception (strategy 3 versus 2), the total cost would be $10 billion with a gain of 554,575 QALYs. For a routine trial of GnRH agonists to be the preferred strategy after failing hormonal contraception, rather than surgery, the cost of GnRH agonists would have to be less than 80% of their current cost. Our tornado diagram identified the probability of improvement with surgery as a key input. The probability of cure with surgery would need to exceed 82% for it to be the preferred first line treatment method. While care must be individualized, our findings suggest that stepwise treatment with more than one medical modality prior to surgery is a cost-effective approach to endometriosis management.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Characteristics of Women with Recurrent Endometriosis Pain after Laparoscopy and Levonorgestrel Intrauterine Device Placement

Introduction The levonorgestrel (LNG)-intrauterine device (IUD) is effective for many, but not all, women with endometriosis in managing pelvic pain. The aim of this study was to explore the characteristics associated with recurrent endometriosis pain within 12 months after operative laparoscopy and LNG-IUD placement. Methods This retrospective case series was performed at a university-affiliated infertility and reproductive surgery practice and included women who underwent operative laparoscopy and LNG-IUD placement by a single surgeon from January 1, 2012 to October 7, 2015 (n = 32). Within 12 months post-operatively, the primary surgeon assessed pain reported by the patient and prescribed adjunctive oral hormonal therapy for recurrent pain symptoms. Data were collected using the patients’ electronic medical records. The main outcome was the presence of recurrent endometriosis pain within 12 months after operative laparoscopy with LNG-IUD placement. Results Of the 32 women who underwent laparoscopy and LNG-IUD placement, 26 presented for follow-up (81.2%) within 12 months, 15 of whom (57.7%) reported recurrent pain. The odds of poor pain control were higher among the women who were obese, among those who had undergone prior laparoscopy, and among those with a history of asthma, depression, or headaches. Conclusions The optimal management of endometriosis-related pain is highly patient-specific, and poor response to LNG-IUD may be associated with having had a prior laparoscopy, obesity, and certain medical comorbidities.