Seven studies (n=217) were included in the review. There were five prospective non-comparative studies (limited quality), one RCT (adequate quality) and one patient-preference cohort study (moderate quality).
Aromatase inhibitors: Administration of vaginal anastrozole 0.25mg/day for six months (n=9, non-comparative) significantly decreased pain during treatment. Administration of oral letrozole plus progestin (n=12) significantly decreased pain during treatment and improved quality of life. Neither drug influenced endometrial foci size.
Gonadotrophin-releasing hormone agonists: Administration of leuprolide acetate 3.75mg/28 days (n=15, non-comparative) for six months significantly reduced pain during treatment.
Progestins: Administration of a levonorgestrel-releasing intrauterine device for 12 months (n=11, non-comparative) significantly reduced pain during treatment and had a slight but significant reduction in lesion size.
Danazol: Administration of vaginal danazol 200mg/day for 12 months (n=21, non-comparative) significantly reduced pain during treatment and significantly reduced lesion size.
Oestrogen-progestin combinations: Studies of use of a vaginal ring ethinylestradiol 0.015 mg plus etonogestrel 0.12 mg/day (n=38, patient preference) or transdermal patch ethinyl oestradiol
0.02 mg plus norelgestromin 0.15 mg/day (n=21, patient preference) found that pain was reduced by both methods, but was more effective for the ring. More patients were satisfied with the ring (79%) treatment than the patch (57%). Administration of oral treatments (n=90, RCT) reduced pain and reduced lesion size. Five patients withdrew due to side effects.