Comparison of Cyproterone Acetate and Danazol in the Treatment of Pelvic Pain Associated With Endometriosis

Fedele, Luigi; Arcaini, Luisa; Bianchi, Stefano; Baglioni, Angelo; Vercellini, Paolo

doi:10.1097/00006250-198906000-00019

Cited by 40 publications

(19 citation statements)

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“…Cyproterone acetate, a progestin with antiandrogenic activity, was given in combination with 0.035 mg ethinyl estradiol to 11 women in a comparison study with 600 mg/day danazol given to 12 women. 16 Treatment was carried out for 6 months. Diagnostic laparoscopy was performed in subjects prior to medication; no mention was made of surgical therapy at the time of laparoscopy.…”

Section: Progestins and Oral Contraceptivesmentioning

confidence: 99%

“…Vercellini's group 10 used the same cyclic ethinyl estradiol/ desogestrel-containing oral contraceptive with a 50 mg/day dose of danazol in comparison with depot MPA. Fedele's group 16 compared danazol with the combination of cyproterone acetate and ethinyl estradiol, which is marketed in some countries as an oral contraceptive but is dissimilar to oral contraceptives available in the United States. Taking all three of these studies together, oral contraceptive-containing regimens may be comparable to depot MPA and to GnRH analog therapy.…”

Section: Progestins and Oral Contraceptivesmentioning

confidence: 99%

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Medical and Surgical Therapies for Pain Associated with Endometriosis

Winkel

Scialli

2001

Journal of Women's Health & Gender-Based Medicine

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Endometriosis is a common condition for which a number of treatments have been proposed. Medical treatments are based on the hormonal responsiveness of endometriosis implants. These therapies include progestins (with or without estrogens), androgens, and gonadotropin-releasing hormone (GnRH) analogs. Surgical treatments may include hysterectomy with oophorectomy or organ-sparing surgery involving ablation or resection of visible lesions of endometriosis and restoration of pelvic anatomy. There are no studies that directly compare the effectiveness or adverse effects of medical therapy and surgical therapy. Studies on medical therapy compare different treatments with placebo or with other active treatments. Hormone-based therapies for endometriosis show 80%-100% effectiveness in relief of pelvic pain over a 6-month course of therapy. Serious adverse outcomes after medical therapy are unusual. Studies on surgical therapy are largely anecdotal, with noncomparative reports on a variety of surgical methods. A few comparative surgical studies have been reported. Because of the noncomparative nature of many of the surgical studies, the use of combinations of surgical procedures and techniques in the reported studies, and the reporting of results from surgeons with an unusually high level of technical skill, the gynecological practitioner has little basis in the literature for assessing the optimum surgical approach. Surgical complications are believed to be underreported and may be related to how aggressive a surgical procedure is undertaken.

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Section: Progestins and Oral Contraceptivesmentioning

confidence: 99%

Section: Progestins and Oral Contraceptivesmentioning

confidence: 99%

Medical and Surgical Therapies for Pain Associated with Endometriosis

Winkel

Scialli

2001

Journal of Women's Health & Gender-Based Medicine

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“…L'effet potentiellement réversible du traitement médical sur la douleur est expliqué par un effet suppressif et non pas curatif au niveau des implants (NP3) [27]. L'effet suppressif peut être maintenu pendant la durée du traitement, mais les symptômes douloureux peuvent réapparaître dans les mois suivant l'arrêt du traitement [22,28]. Le traitement médical a un effet suppressif sur les douleurs (grade A).…”

Section: Efficacité Des Traitements Médicaux Sur Les Douleurs D'endomunclassified

Prise en charge d'une endométriose douloureuse

Roman

2007

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

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“…Porém, mais estudos devem ser realizados para defi nir sua utilização em pacientes com dor pélvica e endometriose 41,42 . Outras vias de administração de progestáge-nos têm sido testadas, como implante subdérmico de etonorgestrel e o sistema intra-uterino com liberação lenta de levonorgestrel (SIU-LNG).…”

Section: Progestágenos E Contraceptivos Orais Combinadosunclassified

Tratamento da endometriose

Navarro

Barcelos

Silva

2006

Rev. Bras. Ginecol. Obstet.

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RESUMOApesar da grande heterogeneidade das manifestações clínicas relacionadas à endometriose, observa-se a sua elevada prevalência em mulheres inférteis e portadoras de dor pélvica crônica. O impacto sócio-econômico desta afecção enigmática é elevado e os dados relacionados à efi cácia das diferentes abordagens terapêuticas descritas são bastante confl itantes. Assim, os objetivos do presente artigo são apresentar as evidências científi cas disponíveis acerca das diferentes modalidades terapêuticas aplicáveis e estabelecer recomendações para o tratamento da infertilidade e da dor pélvica crônica relacionadas à endometriose. Em pacientes com endometriose mínima ou leve a supressão da função ovariana não é efetiva para melhorar a fertilidade, mas a ablação das lesões associadas à adesiólise parece ser mais efetiva do que a realização exclusiva da laparoscopia diagnóstica. Não há evidências sufi cientes para determinar se a excisão cirúrgica em casos de doença moderada ou severa melhoraria as taxas de gestação. A fertilização in vitro parece ser uma abordagem adequada, especialmente nos casos de coexistência de fatores de infertilidade e/ou falha de outras abordagens terapêuticas. Deve-se avaliar a possibilidade de usar agonistas do GnRH por 3 a 6 meses, previamente à realização de fertilização in vitro. Em relação ao alívio da dor, verifi ca-se que a supressão da função ovariana por 3 a 6 meses em pacientes com doença confi rmada laparoscopicamente reduz a dor associada à endometriose. Todas as medicações estudadas parecem apresentar efi cácia similar, embora os efeitos adversos e de os custos sejam diferentes. A ablação das lesões endometrióticas reduz a dor associada à endometriose, sendo menos efetiva nos casos de doença mínima. A exérese de endometriomas com diâmetro > 4 cm parece melhorar a taxa de fecundidade natural e após procedimentos de reprodução assistida, além de reduzir a dor e os riscos de recidiva. Por fi m, é importante ressaltar que há muita controvérsia e que as recomendações acima descritas deverão ser revistas à medida que estudos clínicos randomizados, controlados e com casuística adequada gerarem evidências mais concretas e confi áveis. PALAVRAS-CHAVE:Endometrios/terapia; Infertilidade feminina; Dor pélvica; Reprodução; Técnicas reprodutivas assistidas ABSTRACT Despite a wide heterogeneity of clinical manifestations related to endometriosis, a high prevalence of the disease is observed in infertile women and in those with chronic pelvic pain. This enigmatic condition has a high socioeconomic impact, and the described data regarding effi cacy of the therapeutic approaches are quite confl icting. Thus, the purpose of the present study was to describe the available scientifi c evidence about the applicable therapeutic modalities and to provide recommendations for the treatment of infertility and the chronic pelvic pain related to endometriosis. Although suppression of ovarian function in patients with minimal or mild endometriosis is not effective in improving fertility, ablation of the lesion...

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Comparison of Cyproterone Acetate and Danazol in the Treatment of Pelvic Pain Associated With Endometriosis

Cited by 40 publications

References 0 publications

Medical and Surgical Therapies for Pain Associated with Endometriosis

Medical and Surgical Therapies for Pain Associated with Endometriosis

Prise en charge d'une endométriose douloureuse

Tratamento da endometriose

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