Comparing the Efficacy of Surgery and Medical Therapy for Pain Management in Endometriosis: A Systematic Review and Meta-analysis.
Pain is considered as one of the main symptoms of endometriosis. The treatment for endometriosis remains controversial.



The aim of this study is to compare the effect of medical or surgical treatments for pain-relief in patients with endometriosis.



Systematic review and meta-analysis.



Published papers about evaluating pain treatment in endometriosis in PubMed, Scopus, and Google Scholar.



After searching all studies evaluating pain treatment in endometriosis in PubMed, Scopus, and Google Scholar, there were 23 related studies, containing 1,847 patients enrolled in our study. We used a variety of tests: fixed and random effects models, Q Cochrane test and I2 index, Egger and Begg tests, forest and funnel plots, Trim and fill method, and meta-regression in our analysis.



There was no statistically significant difference in pain improvement between surgical and medical treatment. Interestingly, pain relief was more prominent longer after treatment. Both clinical trials and cross sectional studies showed higher improvement in pain than cohort studies. High quality studies and lower body mass index (BMI) had a greater effect on pain relief. All studies were heterogeneous, but there was no publication bias.



There was a higher probability of risk of bias in blinding, random sequence generation, and selective outcome reporting in clinical trial studies entered in our meta-analysis.



Our results could not demonstrate the preference of each medical or surgical treatment effect for dysmenorrhea in endometriosis. Additional data is required before a standardized medical protocol can be offered, but we believe this study may encourage clinicians to consider a less invasive alternative for treating their patients' chronic pelvic pain in the near future.Key words: Endometriosis, pain, meta-analysis, therapy, disease management.
Minimally Invasive Techniques Research Center in women, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.
Shahla
S
Chaichian
Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
Ali
A
Kabir
Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran.
Adolfazl
A
Mehdizadehkashi
Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran; Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Khaled
K
Rahmani
Department of Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mehrdad
M
Moghimi
Obstetrician and Gynecologist, Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Tehran, Iran.
Bahram
B
Moazzami
D002986:Clinical Trials as Topic; D003430:Cross-Sectional Studies; D004715:Endometriosis / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D059408:Pain Management / Q000379:methods*; D017699:Pelvic Pain / Q000188:drug therapy* / Q000601:surgery*