How effective are interventions for premenopausal women with pain or subfertility associated with endometriosis?
For women with pain and endometriosis, suppression of menstrual cycles with gonadotrophin-releasing hormone analogues (GnRHa), the levonorgestrel-releasing intrauterine system and danazol were beneficial. Laparoscopic treatment of endometriosis and excision of endometriomata were also associated with improvements in pain. The evidence on non-steroidal anti-inflammatory drugs was inconclusive. There was no evidence of benefit with postsurgical medical treatment. In women with endometriosis undergoing assisted reproduction, 3 months prior treatment with GnRHa improved pregnancy rates. Excisional surgery improved spontaneous pregnancy rates in the 9 to 12 months after surgery, compared with ablative surgery. Laparoscopic surgery improved live birth and pregnancy rates compared with diagnostic laparoscopy alone. There was no evidence medical treatment alone improved clinical pregnancy rates. Evidence on harms was scanty, but GnRHa, danazol and depot progestogens were associated with higher rates of adverse effects than other interventions.
The quality of the evidence reported by the primary studies ranged from very low to moderate. The main reasons for the quality of the evidence being downgraded were bias in the primary studies (inadequate reporting of allocation concealment and randomisation methods, lack of blinding) and imprecision. The evidence was frequently restricted to a single small trial.
Endometriosis is characterised by the presence of endometrial tissue in sites other than the uterine cavity. It is a common gynaecological condition, affecting women in their reproductive years and is generally believed to be an oestrogen-dependent disorder. Estimates of prevalence in the general population are up to 10%.1 For women with subfertility, the prevalence rate ranges from 25% to 40%.1