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Fertil Steril. 1993 Jul;60(1):75-9.

A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis.

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Clinica Ostetrica e Ginecologica L. Mangagalli, University of Milan, Italy.



To evaluate the efficacy of goserelin versus a low-dose cyclic oral contraceptive (OC) in improving pelvic pain in women with endometriosis and to compare recurrence of symptoms during follow-up.


Open-label, randomized trial.


University hospital endometriosis center.


Fifty-seven women with moderate or severe pelvic pain and laparoscopically diagnosed endometriosis.


Six-month treatment with goserelin depot (n = 29) or a low-dose cyclic OC (n = 28) followed by 6-month follow-up.


Variation in severity of symptoms during treatment and at the end of follow-up as shown by a linear analog scale and a verbal rating scale.


At 6 months of treatment, a significant reduction in deep dyspareunia was observed in both groups, with goserelin superior to the OC at linear analog scale assessment. Nonmenstrual pain was diminished on both scales without differences between treatments. Women taking the OC experienced a significant reduction in dysmenorrhea. At the end of follow-up, symptoms reappeared without differences in severity between the groups.


Low-dose cyclic OCs may be a valuable alternative for the treatment of dysmenorrhea and nonmenstrual pain associated with endometriosis. Symptoms recurred in most subjects 6 months after drug withdrawal.


Physicians at the University of Milan in Italy compared data on 29 endometrial patients who received 3.6 mg goserelin in a 28-day subcutaneous depot formulation for 6 months to treat nonmenstrual pelvic pain, dysmenorrhea, and pain during coitus (dyspareunia) with data on 28 other endometrial patients treated with a low-dose monophasic oral contraceptive (OC) (.02 mg ethinyl estradiol and 0.15 mg desogestrel) for 6 months. They followed the women for 6 months after treatment ended. The physicians wanted to determine the efficacy of goserelin, a gonadotropin-releasing hormone (GnRH) agonist, versus a low dose OC to relieve pelvic pain in patients with endometriosis and to compare pain recurrence after drug withdrawal. (GnRH agonists are current medical treatments for pelvic pain, but they have several side effects and are expensive; and therefore their use is restricted.) At the end of treatment, both goserelin and the low-dose OC significantly reduced dyspareunia (p .01), especially goserelin according to the linear analog scale (pain symptom score, 1.8 points lower). Both treatments improved nonmenstrual pain equally at the end of treatment (p .01). The low-dose OC reduced dysmenorrhea greatly at the end of treatment (p .01). The researchers could not evaluate dysmenorrhea in goserelin cases, since these patients experienced amenorrhea. The only persistent significant reduction at the end of follow-up occurred with dyspareunia in goserelin patients (p .05). In the other patients, pelvic pain returned to baseline levels 6 months after treatment ended. The severity of pelvic pain did not differ between groups 6 months after follow-up. These results suggested that low-dose OCs may be an effective alternative treatment for dysmenorrhea and nonmenstrual pelvic pain linked to endometriosis.

[Indexed for MEDLINE]

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