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Endometriosis
JOSHUA H. TAMAYO-SARVER AND RITA K. CYDULKA
n Agents
n NSAIDs
n Combined oral contraceptive pills
n Medroxyprogesterone
n Danazol
n Gonadotropin-releasing hormone (GnRH) agonists
n Evidence
NSAIDs are widely considered first-line therapy for the pain associated with
endometriosis, although there is little more than anecdotal evidence supporting
their use. 1–6 In fact, only one RCT is identified in a 2005 Cochrane
review. 2 The study, which assessed utility of naproxen (275 mg PO QID) for
endometriosis, found that the NSAID offered no advantage over placebo. 7
Some potential utility for NSAIDs in endometriosis is supported by another
trial, which found clinical relief for women with the condition who took the
COX-2 selective NSAID rofecoxib (25 mg PO QD). 8
When NSAIDs are contraindicated or fail (and assuming the endometriosis
diagnosis is confirmed), the remaining therapies fall under the general category
of endocrine agents with antiovulatory activity. Combined oral contraceptive
pills (COCPs) are generally recommended as the second-line therapy for endometriosis
pain. 1,3–7 The best evidence for the COCPs in endometriosis is found
in a study of women receiving monophasic ethinyl estradiol/desogestrel (0.02/
0.15 mg PO daily) for six months; subjects on this regimen reported improvement
in dysmenorrhea, dyspareunia, and nonspecific pelvic pain. 9 While
the evidence is imperfect, a 2007 Cochrane review concluded that COCPs are
at least as effective as gonadotropin-releasing hormone (GnRH) agonists. 10
Medroxyprogesterone acetate (100mg PO daily) is comparable to the
androgen danazol (600 mg PO daily), with both agents reducing pain scores
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