Hormonal and complimentary treatments for endometriosis: a narrative review
Arissa Onishi1, Cristina Laguna Benetti-Pinto1, Daniela Angerame Yela1
1Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas (Unicamp), Campinas (SP), Brazil.
Background And Objective:
Endometriosis causes infertility and pain and is associated with detriment to quality of life. The aim is to review hormonal and complementary treatments for pain in women with endometriosis. Up until this review was registered on PROSPERO, no other review had focused exclusively on hormonal and complementary treatments for endometriosis. Prior reviews broadly covered surgical, hormonal, and complementary treatments.
Methods:
This narrative review was carried out by searching the PubMed, Virtual Health Library and Embase databases for publications in English or Portuguese from 2014 to 2024 about hormonal and complementary treatments. Studies were selected if they focused on endometriosis treatment and a pain scale or quality of life questionnaire were specified.
Key Content And Findings:
A total of 1,201 publications were identified. After excluding duplications and applying inclusion criteria, 48 studies remained, of which 33 were selected for this review. Dienogest is the most studied therapy, with evidence of its use as first-line treatment. Combined oral pills were superior to placebo and have comparable efficacy to dienogest. Gonadotropin-releasing hormone (GnRH) agonists should be prescribed on a short-term basis, as second-line treatment, considering the side effects, impacts on bone mineral density and cardiovascular health. GnRH antagonists represent a promising therapy, due to dose-dependent hypoestrogenism, minimizing side effects compared to agonists. However, they have not been compared to first-line treatments and so far, should be reserved for cases of treatment failure. Findings suggest that complementary therapies seem to have an important role in adjuvant pain control. However, it is difficult to assess the isolated effect of these therapies because the studies involve multiple concurrent interventions and are not placebo-controlled.
Conclusions:
Progestins and combined oral contraceptive pills are first-line treatments and GnRH analogues are second-line treatments according to studies with good quality evidence. Complementary treatments lack good quality evidence.
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