The efficacy of drugs in the management of endometriosis.
OBJECTIVE
To establish the crude effects of danazol and gonadotropin-releasing hormone (GnRH) analogs in the management of endometriosis.


METHODS
Prospective case-control study.


METHODS
Unit of the Pathophysiology of Reproduction outpatient department.


METHODS
Two groups of 110 women each with endometriosis (American Fertility Society score 1-3) who received danazol and GnRH analogs, and a control group who did not receive any drugs.


METHODS
Women in the treatment groups received danazol 200 mg every 8 hours for 6 months, or a different GnRH agonist at standard dosages for 6 months. Laparoscopy was performed twice, at the time of diagnosis and just before the end of treatment (or no therapy for controls). Surgical treatment of the implants was performed at the second laparoscopy.


RESULTS
Samples of both eutopic and ectopic endometrium were collected during both laparoscopies. Both danazol and GnRH agonists were useful in reducing the AFS scores to inactive endometriotic implants, and there were no significant differences between the effects (p <0.001). Fibrosis was found after 6 months of observation in the implants in one control woman (0.9%), in 20 patients (18.2%) treated with danazol (p <0.001 vs controls), and in 4 patients (3.6%) treated with GnRH agonists (NS vs controls). A correlation between a clinical diagnosis of AFS score zero and histologic features of fibrosis in the ectopic specimens after therapies was observed in 28% of women, with poor agreement (k = 0.07).


CONCLUSIONS
Fibrosis, which represent the absence of endometrial cells within the specimens of endometriotic lesions or eutopic endometrium, did not appear in eutopic endometria but it was found in some endometriotic implants. Danazol and GnRH agonists reduced the clinical AFS scores of endometriosis, but their histologic effects in completely and permanently eliminating endometriotic implants were unacceptable.
Bulletti
C
C
Unit of Special Pelvic Surgery, Operative Laparoscopy and Hysteroscopy, First Institute of Obstetrics and Gynecology, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy.
Flamigni
C
C
Polli
V
V
Giacomucci
E
E
Albonetti
A
A
Negrini
V
V
Galassi
A
A
Morselli-Labate
A M
AM
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003613:Danazol / Q000627:therapeutic use; D004715:Endometriosis / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D004717:Endometrium / Q000473:pathology; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D005355:Fibrosis; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000627:therapeutic use; D006801:Humans; D010535:Laparoscopy; D011446:Prospective Studies
D004965:Estrogen Antagonists; D007987:Gonadotropin-Releasing Hormone; D003613:Danazol