Pharmacologic Interventions for Endometriosis-Related Pain: A Systematic Review and Meta-analysis

Area of Science:

• Gynecology
• Pharmacology
• Evidence-Based Medicine

Background:

• Endometriosis is a chronic condition causing significant pelvic pain.
• Pharmacological interventions are commonly used to manage endometriosis-related pain.
• Comparative effectiveness data for these treatments are crucial for clinical decision-making.

Purpose of the Study:

• To conduct a network meta-analysis evaluating the efficacy of various medications for endometriosis-related pain.
• To compare the effectiveness of different pharmacological interventions against placebo.
• To identify the most effective treatments for overall endometriosis-associated pelvic pain, dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain.

Main Methods:

• Systematic literature search of PubMed, Embase, Web of Science, and Cochrane Controlled Trials Register up to July 2024.
• Inclusion of 31 randomized controlled trials (RCTs) involving 8,665 patients.
• Network meta-analysis adhering to PRISMA guidelines, assessing endometriosis-associated pelvic pain, dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain.

Main Results:

• Leuprolide with combined oral contraceptive pills (OCPs), dienogest, leuprolide alone, and combined OCPs showed significant efficacy over placebo for overall pelvic pain.
• Leuprolide with combined OCPs was the most effective treatment modality for general endometriosis pain.
• Elagolix and vitamins C/E combination were effective for dysmenorrhea and dyspareunia, while gestrinone was superior for nonmenstrual pelvic pain.

Conclusions:

• Leuprolide with combined OCPs, elagolix, vitamins C and E, and gestrinone are identified as highly effective options for endometriosis pain management.
• These findings provide valuable insights into the comparative efficacy of treatments for endometriosis-associated pain.
• Further large-scale, rigorous clinical trials are recommended to validate these results in target populations.