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198 Endometriosis
by 50–74% compared with placebo. 11 Similarly, a depot preparation of
medroxyprogesterone acetate (150 mg IM q3 months) is comparable to
ethinyl estradiol/desogestrel (0.02/0.15 mg PO daily) plus danazol (50 mg
PO daily while taking the oral contraceptive pills). 12 An SC form of depot
medroxyprogesterone appears to relieve endometriosis as effectively as the
proven approach of the GnRH agonist leuprolide acetate (3.75–11.25 mg IM
q1–3 months). 13
Other endocrine approaches, including the synthetic steroid gestrinone and
a levonorgestrel-releasing intrauterine device, are efficacious in the outpatient
setting but have limited ED utility unless they are prescribed in close cooperation
with follow-up providers. Cochrane review has shown that there is
generally equivalent pain relief achieved with multiple endocrine therapies
for endometriosis. 10 The myriad menopausal, androgenic, and hepatic side
effects from some of the endocrine agents (e.g. danazol) used to treat endometriosis
should serve to underline the importance of ED physician communication
and follow-up arrangements with longitudinal care providers. 14
n Summary and recommendations
First line: NSAID (e.g. ibuprofen 600–800 mg PO TID)
Reasonable: medroxyprogesterone (100 mg PO QD or 150 mg depot IM q3
months)
Pediatric: NSAID (e.g. ibuprofen 600–800 mg PO TID)
Special case:
n failure of initial therapies and in close consultation with gynecologist:
danazol (600 mg PO QD) or leuprolide acetate (3.75 mg IM monthly)
References
1. Jackson B, Telner DE. Managing the misplaced: approach to endometriosis.
Can Fam Physician. 2006;52(11):1420–1424.
2. Allen C, Hopewell S, Prentice A. Non-steroidal anti-inflammatory drugs for pain
in women with endometriosis. Cochrane Database Syst Rev. 2005(4):CD004753.