( S ) Few studies of medical therapies for endometriosis report outcomes that are relevant to patients , and many women gain only limited or intermittent benefit from treatment
OBJECTIVE To assess patient response rates to medical therapies used to treat endometriosis-associated pain .
Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. Effect on pain during intercourse and patient satisfaction.
STUDY QUESTION Does surgical or medical treatment for endometriosis-associated severe deep dyspareunia achieve better results in terms of patients ' satisfaction ( main study outcome ) , variation of coital pain and frequency of intercourse ? SUMMARY ANSWER Surgery and progestin therapy were equally effective in the treatment of deep dyspareunia in women with rectovaginal endometriosis , whereas medical therapy performed significantly better than excisional treatment in those without deeply infiltrating lesions . WHAT IS KNOWN AND WHAT THIS PAPER ADDS Conservative surgery and hormonal therapies have been used independently for endometriosis-associated deep dyspareunia with inconsistent results . This study reports a direct comparison between the two treatment options in women with severe pain during intercourse . DESIGN Patient preference , parallel cohort study with a 12-month follow-up . The effect of conservative surgery at laparoscopy was compared with treatment with a low-dose of norethisterone acetate per os ( 2.5 mg/day ) in women with persistent/recurrent severe deep dyspareunia after first-line surgery . PARTICIPANTS AND SETTING A total of 51 patients chose repeat surgery and 103 progestin treatment .  Patient satisfaction was grade d according to a five-category scale . Variations in pain during intercourse were measured by means of a 100-mm visual analogue scale . MAIN RESULTS AND THE ROLE OF CHANCE In the surgery group , a marked and rapid short-term dyspareunia score reduction was observed , followed by partial recurrence of pain . The pain relief effect of the progestin was more gradual , but progressive throughout the study period . At a 12-month follow-up , the frequency of intercourse per month ( mean ± SD ) was 4.6 ± 1.8 in the surgery group and 5.3 ± 1.5 in the norethisterone acetate group ( P = 0.02 ) . A total of 22/51 ( 43 % ) women were satisfied in the surgery group compared with 61/103 ( 59 % ) in the progestin group [ adjusted odds ratios ( OR ) , 0.36 ; 95 % confidence interval ( CI ) , 0.16 - 0.82 ; P = 0.015 ] . Corresponding figures in women with and without rectovaginal endometriotic lesions were , respectively , 13/24 ( 54 % ) versus 18/35 ( 51 % ; adjusted OR , 0.77 ; 95 % CI , 0.22 - 2.67 ; P = 0.68 ) , and 9/27 ( 33 % ) versus 43/68 ( 63 % ; adjusted OR , 0.23 ; 95 % CI , 0.07 - 0.76 , P = 0.02 ) . BIAS , CONFOUNDING , AND OTHER REASONS FOR CAUTION : Treatments were not r and omly assigned , and distribution of participants as well as of dropouts between study arms was unbalanced . However , the possibility of choosing the treatment allowed assessment of the maximum potential effect size of the interventions . GENERALIZABILITY TO OTHER POPULATION S Caucasian patients able to choose their treatment . STUDY FUNDING /COMPETING INTEREST(S ) This study was supported by a research grant from the University of Milan School of Medicine ( PUR number 2009-ATE-0570 ) . None of the authors have a conflict of interest
( S ) Few studies of medical therapies for endometriosis report outcomes that are relevant to patients , and many women gain only limited or intermittent benefit from treatment
OBJECTIVE To assess patient response rates to medical therapies used to treat endometriosis-associated pain .