Medical Therapies: Randomized Controlled Trials/Traditional Medical Therapies

For a subjective outcome such as pain, only randomized controlled trial evidence adds materially to our understanding of efficacy of medical interventions. All traditional hormonal medical treatments (including the combined oral contraceptive pill, progestins, danazol, gestrinone and gonadotropin releasing hormone analogs) are effective for reducing endometriosis-related pain. Overall, they appear to be similarly effective, although those providing amenorrhea are particularly useful where the predominant symptom is dysmenorrhea. There is little randomized trial evidence to compare medical versus surgical treatments. For pain outcomes alone, there is little evidence to support routine preoperative or postoperative medical treatment as an adjunct to surgery. Newer treatments, such as pentoxifylline, believed to act through an immunomodulatory mechanism, merit further investigation.