Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III-IV. A randomized comparative trial.
OBJECTIVE
To evaluate the effectiveness for the outcomes of endometriosis-related pain and quality of life of conservative surgery plus placebo compared with conservative surgery plus hormonal suppression treatment or dietary therapy.


METHODS
Randomized comparative trial.


METHODS
University hospital.


METHODS
Two hundred twenty-two consecutive women who underwent conservative pelvic surgery for symptomatic endometriosis stage III-IV (r-AFS).


METHODS
Six months of placebo (n = 110) versus GnRH-a (tryptorelin or leuprorelin, 3.75 mg every 28 days) (n = 39) or continuous estroprogestin (ethynilestradiol, 0.03 mg plus gestoden, 0.75 mg) (n = 38) versus dietary therapy (vitamins, minerals salts, lactic ferments, fish oil) (n = 35).


METHODS
Painful symptoms (visual analogue scale score) and quality-of-life endometriosis-related symptoms (SF-36 score) at 12 months' follow-up.


RESULTS
Patients treated with postoperative hormonal suppression therapy showed less visual analogue scale scores for dysmenorrhoea than patients of the other groups. Hormonal suppression therapy and dietary supplementation were equally effective in reducing nonmenstrual pelvic pain. Surgery plus placebo showed significative decrease in dyspareunia scores. Postoperative medical and dietary therapy allowed a better quality of life than placebo.


CONCLUSIONS
Postoperative hormonal suppression treatment or dietary therapy are more effective than surgery plus placebo to obtain relief of pain associated with endometriosis stage III-IV and improvement of quality of life.
Sesti
Francesco
F
Endometriosis Center, Section of Gynecology & Obstetrics, Department of Surgery, Tor Vergata University Hospital, Rome, Italy. Francesco.Sesti@uniroma2.it
Pietropolli
Adalgisa
A
Capozzolo
Talia
T
Broccoli
Patrizia
P
Pierangeli
Silvia
S
Bollea
Maria Rosa
MR
Piccione
Emilio
E
D000328:Adult; D003131:Combined Modality Therapy; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D004338:Drug Combinations; D004412:Dysmenorrhea / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology; D004414:Dyspareunia / Q000178:diet therapy / Q000188:drug therapy; D004715:Endometriosis / Q000178:diet therapy / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D004997:Ethinyl Estradiol / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use*; D009652:Norpregnenes / Q000627:therapeutic use*; D034445:Ovulation Inhibition / Q000187:drug effects; D010149:Postoperative Pain / Q000178:diet therapy* / Q000188:drug therapy* / Q000209:etiology; D010919:Placebos
D003278:Contraceptives, Oral, Hormonal; D004338:Drug Combinations; D009652:Norpregnenes; D010919:Placebos; C494367:estroprogestin; D007987:Gonadotropin-Releasing Hormone; D004997:Ethinyl Estradiol; D016729:Leuprolide