Cyproterone acetate versus a continuous monophasic oral contraceptive in the treatment of recurrent pelvic pain after conservative surgery for symptomatic endometriosis.
OBJECTIVE
To evaluate the efficacy and safety of cyproterone acetate versus an oral contraceptive in the treatment of endometriosis-associated recurrent pelvic pain.


METHODS
Randomized controlled trial.


METHODS
Academic center.


METHODS
Ninety women with recurrent moderate or severe pelvic pain after conservative surgery for symptomatic endometriosis.


METHODS
Six months of continuous treatment with oral cyproterone acetate, 12.5 mg/d, or an oral contraceptive containing ethinyl estradiol, 0.02 mg, and desogestrel, 0.15 mg.


METHODS
Degree of satisfaction with therapy.


RESULTS
Six patients in the cyproterone acetate arm and nine in the oral contraceptive arm withdrew because of side effects (n = 9), treatment inefficacy (n = 4), or loss to follow-up (n = 2). At 6 months, dysmenorrhea, deep dyspareunia, and nonmenstrual pelvic pain scores were substantially reduced, and significant improvements were observed in health-related quality-of-life, psychiatric profile, and sexual satisfaction; no major between-group differences were seen. Subjective and metabolic side effects were limited. According to an intention-to-treat analysis, 33 of 45 (73%) of patients in the cyproterone acetate group and 30 of 45 (67%) in the oral contraceptive group were satisfied with the treatment received.


CONCLUSIONS
Both cyproterone acetate and a continuous monophasic oral contraceptive were effective, safe, and inexpensive therapy for recurrent pain after conservative surgery for endometriosis.
Vercellini
Paolo
P
Istituto Ostetrico e Ginecologico "Luigi Mangiagalli," University of Milan, Milan, Italy. paolo.vercellini@unimi.it
De Giorgi
Olga
O
Mosconi
Paola
P
Stellato
Giovanna
G
Vicentini
Sarah
S
Crosignani
Pier Giorgio
PG
D000328:Adult; D003276:Contraceptives, Oral / Q000627:therapeutic use*; D017373:Cyproterone Acetate / Q000627:therapeutic use*; D003863:Depression / Q000503:physiopathology; D004412:Dysmenorrhea / Q000503:physiopathology / Q000523:psychology; D004414:Dyspareunia / Q000503:physiopathology; D004715:Endometriosis / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010298:Parity; D018579:Patient Selection; D045167:Progesterone Congeners / Q000627:therapeutic use*; D012008:Recurrence; D011795:Surveys and Questionnaires; D013997:Time Factors
D003276:Contraceptives, Oral; D045167:Progesterone Congeners; D017373:Cyproterone Acetate