Csirzó Ádám, Kovács Dénes Péter, Szabó Anett, Szabó Bence, Jankó Árpád, Hegyi Péter, Nyirády Péter, Ács Nándor, Valent Sándor
Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary.
Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary.
J Clin Med. 2024 Nov 18;13(22):6932. doi: 10.3390/jcm13226932.
: Endometriosis is a chronic condition that affects 6-10% of women of reproductive age, with pain and infertility being its primary symptoms. The most common aspects of pain are overall pelvic pain, dysmenorrhea, and dyspareunia. Our aim was to compare the available medical treatments for endometriosis-related pain. : A systematic search was conducted in three medical databases to assess available drug options for pain management. Randomized controlled trials (RCTs) investigating various medical treatments for endometriosis-related pain on different pain scales were included. Results were presented as p-scores and, in cases of placebo controls, as mean differences (MD) with 95% confidence intervals (CI). From the available data, a network meta-analysis was carried out. : The search yielded 1314 records, of which 45 were eligible for data extraction. Eight networks were created, and a total of 16 treatments were analyzed. The highest p-score, meaning greatest pain relief (p-score: 0.618), for the treatment of dysmenorrhea was achieved using gonadotropin-releasing hormone (GnRH) agonists for 3 months on a scale of 0-100. Additionally, a p-score of 0.649 was attained following a 6-month treatment with GnRH agonists combined with hormonal contraceptives (CHCs). In the case of dyspareunia on a scale of 0-100 following 3 months of treatment, CHCs (p-score: 0.805) were the most effective, and CHCs combined with aromatase inhibitors (p-score: 0.677) were the best treatment option following 6 months of treatment. In the case of overall pelvic pain, CHCs (p-score: 0.751) yielded the highest p-score on a scale of 0-100 following 3 months of treatment, and progestins combined with aromatase inhibitors (p-score: 0.873) following 6 months of treatment. Progestins (p-score: 0.901) were most effective in cases of overall pelvic pain on a scale of 0-3 following 3 months of treatment. : Our network meta-analysis showed that in cases of dysmenorrhea, GnRH agonists supplemented with CHCs reduced pain the most following 3 months of treatment. Regarding dyspareunia CHCs were most effective, and in the case of overall pelvic pain, CHCs or progestins combined with aromatase inhibitors yielded the most desirable results.
子宫内膜异位症是一种慢性疾病，影响6%-10%的育龄女性，疼痛和不孕是其主要症状。疼痛最常见的表现为盆腔整体疼痛、痛经和性交疼痛。我们的目的是比较现有的针对子宫内膜异位症相关疼痛的医学治疗方法。
在三个医学数据库中进行了系统检索，以评估用于疼痛管理的可用药物选项。纳入了在不同疼痛量表上研究各种子宫内膜异位症相关疼痛医学治疗方法的随机对照试验（RCT）。结果以p值表示，在有安慰剂对照的情况下，以95%置信区间（CI）的平均差异（MD）表示。根据可得数据，进行了网状Meta分析。
检索产生了1314条记录，其中45条符合数据提取条件。创建了8个网络，共分析了16种治疗方法。在0至100的量表上，使用促性腺激素释放激素（GnRH）激动剂治疗三个月，痛经治疗的p值最高，意味着疼痛缓解程度最大（p值：0.618）。此外，GnRH激动剂与激素避孕药（CHC）联合治疗6个月后，p值达到0.649。在0至100的量表上，治疗三个月后，CHC（p值：0.805）在性交疼痛治疗中最有效，治疗六个月后，CHC与芳香化酶抑制剂联合使用（p值：0.677）是最佳治疗选择。在盆腔整体疼痛方面，治疗三个月后，CHC（p值：0.751）在0至100的量表上产生的p值最高，治疗六个月后，孕激素与芳香化酶抑制剂联合使用（p值：0.873）。在0至3的量表上，治疗三个月后，孕激素（p值：0.901）在盆腔整体疼痛治疗中最有效。
我们的网状Meta分析表明，在痛经病例中，GnRH激动剂辅以CHC在治疗三个月后疼痛缓解最多。关于性交疼痛，CHC最有效，在盆腔整体疼痛病例中，CHC或孕激素与芳香化酶抑制剂联合使用产生了最理想的结果。
