Department of Obstetrics and Gynecology, University of Calgary, Alberta, AB, Canada.
Curr Med Res Opin. 2022 Mar;38(3):479-486. doi: 10.1080/03007995.2022.2031144. Epub 2022 Feb 1.
The purpose of this systematic review is to evaluate the evidence for the use of progestin subdermal implants for the treatment of endometriosis-related pain symptoms and quality of life.
A literature search of PubMed, Ovid (MEDLINE and EMBASE), and Web of Science was performed from inception to December 2020. In addition, a targeted search of cited references was also performed. Our search identified 330 articles of which 17 were deemed eligible for full-text review. Eligible studies included randomized control trials, observational studies, and case series with at least 5 cases, investigating the effect of progestin subdermal implants on endometriosis-related pain scores in women of reproductive age with a clinical, radiologic, or surgical diagnosis of endometriosis. Six articles were excluded after the full-text screen.
Eleven articles describing a total of 335 patients were eligible for inclusion. Across all studies, etonogestrel- and segesterone-releasing progestin subdermal implants improved VAS pain scores for cyclic pelvic pain/dysmenorrhea (VAS at baseline ranged from 6.1 to 7.5 cm and after treatment from 1.7 to 4.9 cm, = 121), non-cyclic pelvic pain (baseline VAS 7.2-7.6 cm and after treatment 2.0-3.7 cm, = 96) and dyspareunia (baseline VAS 1.61-8.3 cm and after treatment 1.0-7.1 cm, = 87). Symptom improvement with the progestin subdermal implant was equivalent to treatment with depot medroxyprogesterone acetate (DMPA; average baseline VAS 6.5 and after DMPA treatment 3.0, compared to 2.0 after treatment with the implant) or the 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS; baseline cyclic and non-cyclic pain scores 7.3 and 7.4 respectively decreased to 1.9 and 1.9 after LNG-IUS treatment). Improvements were also demonstrated in quality-of-life scores (average improvement of 36% in all domains of the Endometriosis Health Profile-30 and significant improvements in social functioning, general health, bodily pain, vitality and mental health domains on the Short Form-36 questionnaire) and sexual function (total sexual function score improved from 24 to 25.35 and 26.25 at 6 and 12 months).
Etonogestrel- and segesterone-releasing progestin subdermal implants appear to improve endometriosis-related pain symptoms and quality of life and may provide an additional component in the management of endometriosis. However, this systematic review is limited by the small sample size and heterogeneity in the data. As such, larger prospective randomized trials are needed to guide further management.
CRD42021225665.
本系统评价旨在评估孕激素皮下埋植治疗子宫内膜异位症相关疼痛症状和生活质量的证据。
对 PubMed、Ovid（MEDLINE 和 EMBASE）和 Web of Science 进行了从建库到 2020 年 12 月的文献检索。此外，还对参考文献进行了有针对性的搜索。我们的检索共确定了 330 篇文章，其中有 17 篇被认为符合全文审查标准。符合条件的研究包括随机对照试验、观察性研究和至少 5 例的病例系列研究，调查了孕激素皮下埋植对有生育能力的、经临床、影像学或手术诊断为子宫内膜异位症的女性子宫内膜异位症相关疼痛评分的影响。在全文筛选后，有 6 篇文章被排除。
共有 11 篇描述了 335 名患者的文章符合纳入标准。在所有研究中，依托孕烯和炔诺酮释放孕激素皮下埋植均改善了 VAS 周期性盆腔疼痛/痛经评分（基线 VAS 为 6.1-7.5cm，治疗后为 1.7-4.9cm，=121）、非周期性盆腔疼痛（基线 VAS 为 7.2-7.6cm，治疗后为 2.0-3.7cm，=96）和性交痛（基线 VAS 为 1.61-8.3cm，治疗后为 1.0-7.1cm，=87）。孕激素皮下埋植的症状改善与 Depot 甲羟孕酮（DMPA；平均基线 VAS 为 6.5，DMPA 治疗后为 3.0，而植入物治疗后为 2.0）或 52mg 左炔诺孕酮释放宫内节育系统（LNG-IUS；基线周期性和非周期性疼痛评分分别为 7.3 和 7.4，LNG-IUS 治疗后降至 1.9 和 1.9）相当。生活质量评分也有所改善（所有领域的子宫内膜异位症健康状况量表-30 的平均改善率为 36%，在社会功能、一般健康、躯体疼痛、活力和心理健康领域的简明健康调查问卷有显著改善）和性功能（总性功能评分从 24 分提高到 6 个月和 12 个月时的 25.35 分和 26.25 分）。
依托孕烯和炔诺酮释放孕激素皮下埋植似乎可以改善子宫内膜异位症相关疼痛症状和生活质量，并可能为子宫内膜异位症的治疗提供一个额外的组成部分。然而，本系统评价受到样本量小和数据异质性的限制。因此，需要更大规模的前瞻性随机试验来指导进一步的管理。
PROSPERO 注册号：CRD42021225665。
