Placebo versus medical therapy: 7 RCTs (n=464).
Comparisons of medical treatments: 7 RCTs (n=541).
GnRH analogue versus danazol: 33 RCTs (n=3223).
Danazol versus danazol: 3 RCTs (n=97).
Add-back trials: 16 RCTs (n=1095).
Oral contraceptive pill trials: 2 RCTs (n=99).
Endometrioma treatment: 4 RCTs (n=315).
Preoperative medical treatment: 1 RCT (n=41).
Surgical trials: 6 RCTs (n=578).
Placebo versus medical therapy: in 4 trials (2 of GNRH, 1 of danazol and one of MPA) ORs vary from 0.001 to 0.4 for the symptom of having severe or moderate pain. In a trial of duphaston however the OR was 0.76 (95% CI: 0.18, 3.21).
In one trial, total or partial resolution of peritoneal implants was observed in 60% of patients receiving danazol (p<0.01) and 63% of patients receiving MPA (p<0.01), versus 18% in the placebo group.
In one trial medical treatment was associated with a lower recurrence of pain at 12 months.
GnRH analogue versus danazol: In 5 trials there was no difference between groups at the end of 6 months therapy in occurrence of moderate or severe pain. Eight studies showed no difference between groups for AFS scores at 6 months. Four studies showed no difference between groups for recurrence of symptoms at 12 months. In five trials people in the GnRH group were more likely to discontinue treatment (OR 0.32, 95% CI: 0.21, 0.49). Acne and weight gain occurred more frequently on danazol and hot flushes and vaginal dryness occurred more on GnRH.
Oral contraceptive pill versus GnRH analogues (1 trial): After 6 months dysmenorrhea was more effectively treated by the GnRH analogue than the contraceptive pill. Hot flushes and vaginal dryness were experienced more on GnRH analogue.
GnRH analogues versus GnRH analogues and 'add back' therapy (13 trials): Add back therapy led to a lesser reduction in spinal bone mineral density than GnRH alone initially but there was no difference at 6 months. A consistent reduction in the reported number of hot flushes was noted.
Postoperative medical therapy (3 trials): Danazol and provera were more effective than placebo in reducing pain and AFS scores at the end of treatment and 6 months later. Results on use of GnRH analogues were inconclusive.
Medical therapy (without surgery) for endometriotic cysts (4 trials): No difference between groups were noted except for GnRH analogue used for 3 months after surgical drainage which showed a 50% reduction in cyst diameter.
Laparoscopic ablation (1 trial): laser laparoscopy was compared with diagnostic laparoscopy. At 6 month follow-up 62.5% in the laser group were improved compared to 22.6% in the placebo group. Median decrease in pain score at 6 months was significantly greater in the laser group than the control group.
LUNA (1 trial): 0/10 people in the control group reported relief from dysmenorrhoea compared to 9/11 in the LUNA group at 3 months. At 1 year 5/11 in LUNA group still had relief from dysmenorrhoea.
Presacral neurectomy (2 trials): In one trial 4/4 patients in treatment group reported relief of central dysmenorrhoea at 6 months compared to 0/4 in control group. In another trial at 1 year after surgery 80% of patients in presacral neurectomy + conservative surgery group had successful pain relief compared to 75% in the conservative surgery only group.
Management of subfertility associated with endometriosis: Medical therapy (4 trials) showed no improvement versus placebo. Eight trials showed no difference between danazol and other medical therapy. Laparascopic surgery (2 trials) one trial showed improvement compared to diagnostic laparoscopy (p=0.006).