Depot medroxyprogesterone acetate versus an oral contraceptive combined with very-low-dose danazol for long-term treatment of pelvic pain associated with endometriosis

Abstract

Objective: Our purpose was to evaluate the efficacy and safety of depot medroxyprogesterone acetate versus an oral contraceptive combined with very-low-dose danazol in the long-term treatment of pelvic pain in women with endometriosis.

Study design: Eighty patients with endometriosis and moderate or severe pelvic pain were randomized to treatment for 1 year with intramuscular depot medroxyprogesterone acetate 150 mg every 3 months or a cyclic monophasic oral contraceptive (ethinyl estradiol 0.02 mg, desogestrel 0.15 mg) combined with oral danazol 50 mg a day for 21 days of each 28-day cycle. The women were asked to grade the degree of their satisfaction at the end of therapy. Variations in severity of symptoms during treatment were determined by a 10 cm visual analog and a 0- to 3-point verbal rating scale.

Results: Twenty nine of 40 subjects (72.5%) in the depot medroxyprogesterone acetate group were satisfied after 1 year of therapy compared with 23 of 40 (57.5%) in the oral contraceptive plus danazol group (chi 2(1) = 1.37, p = 0.24, odds ratio 1.95, 95% confidence interval 0.76 to 4.97). A significant decrease was observed in all symptom scores in both study groups. At 1-year assessment dysmenorrhea was significantly greater in women allocated to oral contraceptive plus danazol.

Conclusion: Depot medroxyprogesterone acetate seems to be an effective, safe, and convenient low-cost treatment for pelvic pain associated with endometriosis. However, women should be carefully counseled regarding menstrual changes and the potential prolonged delay in the return of ovulation.

PIP: The tolerability and effectiveness of depot medroxyprogesterone acetate (DMPA), compared with an oral contraceptive (OC) combined with low-dose danazol, in the long-term treatment of pelvic pain in women with endometriosis were evaluated in a randomized clinical trial. 40 women were allocated to each treatment regimen. At the 1-year assessment, a significant decrease was observed in all symptom scores of the visual analog and the verbal rating scale in both study groups. Only pain at menstruation was significantly greater in women in the OC group (because of the absence of regular flow in subjects in the DMPA group). In the DMPA group, 1 woman (2.5%) was very satisfied with her treatment, 28 (70%) were satisfied, 2 (5%) were uncertain, and 1 (2.5%) was very dissatisfied. Corresponding figures for the OC-danazol group were 6 (15%), 17 (42.5%), 4 (10%), 12 (30%), and 1 (2.5%). Overall, 72.5% of women in the DMPA group compared with 57.5% of those in the OC group were pleased after 1 year of treatment. It was concluded that, in selected women with highly symptomatic endometriosis, DMPA offers good analgesic results with tolerable side effects.