de Souza Gaio Giovana, Kemczenski Frederico, Fernandes Oliveira Amador Wellgner, Farias Caroline Freitas, Chagas Júnea
University of Joinville's Region, Department of Medicine Joinville Santa Catarina Brazil.
University of Joinville's Region, Department of Medicine Joinville Santa Catarina Brazil.
Eur J Obstet Gynecol Reprod Biol. 2025 Mar;306:219-225. doi: 10.1016/j.ejogrb.2025.01.033. Epub 2025 Jan 23.
Endometriosis involves the growth of endometrium-like cells outside the uterus, affecting reproductive-aged women. Symptoms such as dysmenorrhea, pelvic pain, and infertility significantly impair quality of life. Among therapeutic options, progestogens have demonstrated efficacy in managing pain and reducing recurrence rates. This study aimed to compare the clinical effectiveness of progestogens versus combined oral contraceptive pills in alleviating pelvic pain, dyspareunia, dysmenorrhea, and associated side effects.
A systematic review and meta-analysis were conducted by searching PubMed, Embase, and the Cochrane Central Register of Controlled Trials, with the last search conducted in October 2024. The review was registered under PROSPERO registration number CRD42024609658. Studies were included regardless of language, publication year, or country. Articles not comparing progestogens and combined oral contraceptives or lacking relevant outcomes were excluded, as were abstracts, theses, case reports, opinion pieces, and correspondence. Risk of bias was assessed using the modified Cochrane Risk of Bias tool 2.0 for randomized studies.
Seven studies, including 948 patients (476 receiving progestogens), met inclusion criteria. The meta-analysis found no significant differences between progestogens and COCPs for pelvic pain (SMD = 0.02; 95 % CI: -0.37 to 0.40; P = 0.04; I = 66.7 %), dysmenorrhea (SMD = 0.00; 95 % CI: -0.19 to 0.19), dyspareunia (SMD = 0.21; 95 % CI: -0.42 to 0.85; P = 0.02; I = 81.4 %), or psychological health (SMD = 0.01; 95 % CI: -0.21 to 0.23; P = 0.19; I = 39.1 %). Similarly, no significant differences were observed in side effects, including breast tenderness, weight gain, amenorrhea, and bleeding.
Progestogens and COCPs demonstrate comparable efficacy in managing pelvic pain, dysmenorrhea, dyspareunia, and psychological health, with similar side effect profiles. These findings suggest both treatments are equally effective options for symptom management in endometriosis.
子宫内膜异位症是指子宫外出现类似子宫内膜的细胞生长，影响育龄女性。痛经、盆腔疼痛和不孕等症状会严重影响生活质量。在治疗方案中，孕激素已证明在控制疼痛和降低复发率方面有效。本研究旨在比较孕激素与复方口服避孕药在缓解盆腔疼痛、性交困难、痛经及相关副作用方面的临床效果。
通过检索PubMed、Embase和Cochrane对照试验中央注册库进行系统评价和荟萃分析，最后一次检索于2024年10月进行。该评价在PROSPERO注册号CRD42024609658下注册。纳入的研究不考虑语言、发表年份或国家。未比较孕激素和复方口服避孕药或缺乏相关结局的文章、摘要、论文、病例报告、观点文章和通信均被排除。使用改良的Cochrane偏倚风险工具2.0对随机研究进行偏倚风险评估。
七项研究，包括948名患者（476名接受孕激素治疗），符合纳入标准。荟萃分析发现，在盆腔疼痛（标准化均数差[SMD]=0.02；95%置信区间[CI]：-0.37至0.40；P=0.04；I²=66.7%）、痛经（SMD=0.00；95%CI：-0.19至0.19）、性交困难（SMD=0.21；95%CI：-0.42至0.85；P=0.02；I²=81.4%）或心理健康（SMD=0.01；95%CI：-
