Cochrane Summaries

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Endometriosis: an overview of Cochrane Reviews

Brown J, Farquhar C
Published Online: 
10 March 2014

Background

Cochrane review authors examined the evidence on endometriosis from Cochrane systematic reviews published in The Cochrane Library. We aimed to summarise the evidence on treatment options that are available to women with pain or subfertility, or both, associated with clinically diagnosed endometriosis.

Study characteristics

We included 17 Cochrane systematic reviews. Fourteen reported measures of pain relief and eight reported fertility outcomes. All the reviews were high quality. The quality of the evidence for specific comparisons and outcomes ranged from very low to moderate, due to limitations in the primary studies, inconsistency between the studies and imprecision in the findings.

Key results

A number of interventions appeared effective in alleviating pain in women with endometriosis. These were gonadotrophin-releasing hormone (GnRH) analogues when compared with placebo, the levonorgestrel-releasing intrauterine system (LNG-IUD) compared with expectant management, danazol compared with placebo, and progestagens and anti-progestagens compared with placebo. Laparoscopic surgical interventions also appeared to be effective for pain.

In women with endometriosis undergoing assisted reproduction, three months of treatment with GnRH agonist improved pregnancy rates. Excisional surgery improved spontaneous pregnancy rates in the nine to 12 months after surgery compared to ablative surgery. Laparoscopic surgery improved live birth and pregnancy rates compared to diagnostic laparoscopy alone. There was no evidence that medical treatment improved clinical pregnancy rates.

Evidence on harms was scanty but GnRH analogues and danazol were associated with higher rates of adverse effects than placebo, and depot progestagens were associated with higher rates than other treatments.

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