title: Letrozole and norethisterone acetate in colorectal endometriosis. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Letrozole and norethisterone acetate versus letrozole and triptorelin in the treatment of endometriosis related pain symptoms: a randomized controlled trial Letrozole and norethisterone acetate in rectovaginal endometriosis. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis? Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Does laparoscopic management of deep infiltrating endometriosis improve quality of life? A prospective study Norethisterone acetate in the treatment of colorectal endometriosis: a pilot study. Continuous low‐dose oral contraceptive in the treatment of colorectal endometriosis evaluated by rectal endoscopic ultrasonography The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Clinical and quality-of-life outcomes after fertility-sparing laparoscopic surgery with bowel resection for severe endometriosis. Letrozole combined with norethisterone acetate compared with norethisterone acetate alone in the treatment of pain symptoms caused by endometriosis. Quality of life after segmental resection of the rectosigmoid by laparoscopy in patients with deep infiltrating endometriosis with bowel involvement. Quantification of endometriosis-associated pain and quality of life during the stimulatory phase of gonadotropin-releasing hormone agonist therapy: a double-blind, randomized, placebo-controlled trial. Sexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection Implanon versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis--a pilot study.
abstract: OBJECTIVE Up to now limited attention has been given to the medical treatment of bowel endometriosis . This study evaluates the efficacy of aromatase inhibitors and norethisterone acetate in treating pain and gastrointestinal symptoms caused by bowel endometriosis . STUDY DESIGN This prospect i ve pilot study included six women with colorectal endometriosis ; all women had intestinal nodules infiltrating at least the muscularis propria of the bowel and did not have a stenosis of the bowel lumen > 60 % ; the patients suffered from pain and intestinal symptoms . The study subjects received letrozole ( 2.5 mg/day ) and norethisterone acetate ( 2.5 mg/day ) continuously for 6 months . The presence and intensity of symptoms were evaluated before starting the treatment , and after 3 and 6 months of treatment . RESULTS The double-drug regimen improved pain , non-menstrual pelvic pain , deep dyspareunia , dyschezia , symptoms mimicking diarrhoea-predominant irritable bowel syndrome , intestinal cramping , abdominal bloating and passage of mucus in the stools , and 67 % of the patients declared that the treatment improved their gastrointestinal symptoms . CONCLUSIONS The administration of letrozole and norethisterone acetate reduces pain and gastrointestinal symptoms of women with colorectal endometriosis , particularly when patients suffer from symptoms mimicking diarrhoea-predominant irritable bowel syndrome OBJECTIVE To examine the effect on pain and quality of life for women with all stages of endometriosis undergoing laparoscopic surgery  compared with placebo surgery . DESIGN A r and omized , blinded , crossover study . SETTING A tertiary referral unit in a district general hospital . PATIENT(S ) Thirty-nine women with histologically proven endometriosis completed the 12-month study . INTERVENTION(S ) Women were r and omized to receive initially either a diagnostic procedure ( the delayed surgical group ) or full excisional surgery ( the immediate surgery group ) . After 6 months , repeat laparoscopy was performed , with removal of any pathology present . MAIN OUTCOME MEASURE(S ) The end points were changes from baseline values of visual analogue pain scores , vali date d quality -of-life instruments ( EQ-5D and SF-12 ) , and sexual activity question naire scores . Patients and assessors of outcomes were blinded to the treatment-group assignment . RESULT ( S ) Significantly more of the 39 women operated on according to protocol reported symptomatic improvement after excisional surgery than after placebo : 16 of 20 ( 80 % ) vs. 6 of 19 ( 32 % ) ; chi(2)(1 ) = 9.3 . Other aspects of quality of life were also significantly improved 6 months after excisional surgery but not after placebo .  Progression of disease at second surgery was demonstrated for women having only an initial diagnostic procedure in 45 % of cases , with disease remaining static in 33 % and improving in 22 % of cases . Nonresponsiveness to surgery was reported in 20 % of cases . CONCLUSION ( S ) Laparoscopic excision of endometriosis is more effective than placebo at reducing pain and improving quality of life . Surgery is associated with a 30 % placebo response rate that is not dependent on severity of disease . Approximately 20 % of women do not report an improvement after surgery for endometriosis Background When aromatase inhibitors are used to treat premenopausal women with endometriosis , additional drugs should be used to effectively down-regulate gonadal estrogen bio synthesis . This r and omized prospect i ve open-label study compared the efficacy in treating pain symptoms and the tolerability of letrozole combined with either norethisterone acetate or triptorelin . Methods Women with pain symptoms caused by rectovaginal endometriosis were treated with letrozole  ( 2.5 mg/day ) and were r and omized to also receive either oral norethisterone acetate ( 2.5 mg/day ; group N ) or intramuscular injection of triptorelin ( 11.25 mg every 3 months ; group T ) . The scheduled length of treatment was 6 months . A visual analogue scale and a multidimensional categorical rating scale were used to assess the severity of pain symptoms . The volume of the endometriotic nodules was estimated by ultrasonography using virtual organ computer-aided analysis . Adverse effects of treatment were recorded . Results A total of 35 women were r and omized between the two treatment protocol s. Significantly more patients in group N rated their treatment as satisfactory or very satisfactory ( 64.7 % ) as compared to group T ( 22.2 % ; p = 0.028 ) . The intensity of both non-menstrual pelvic pain and deep dyspareunia significantly decreased during treatment in both study groups , though no statistically meaningful difference between the two groups was apparent . Reduction in the volume of endometriotic nodules was significantly greater in group T than in group N. Interruption of treatment due to adverse effects significantly differed between the groups , with 8 women in group T ( 44.4 % ) and 1 woman in group N ( 5.9 % ) interrupting treatment ( p = 0.018 ) . Similarly , 14 women included in group T ( 77.8 % ) and 6 women included in group N ( 35.3 % ) experienced adverse effects of treatment ( p = 0.018 ) . During treatment , mineral bone density significantly decreased in group T but not in group N. Conclusions Aromatase inhibitors reduce the intensity of endometriosis-related pain symptoms . Combining letrozole with oral norethisterone acetate was associated with a lower incidence of adverse effects and a lower discontinuation rate than combining letrozole with triptorelin This open-label prospect i ve study evaluated the efficacy of letrozole ( 2.5 mg/day ) combined with norethisterone acetate ( 2.5 mg/day ) in the treatment of  pain symptoms related to the presence of rectovaginal endometriosis . The treatment significantly and quickly decreased the intensity of symptoms , but pain recurred at 3-month follow-up ; five women underwent surgery during the follow-up , and histologic examination of rectovaginal nodules revealed the presence of active endometriotic lesions BACKGROUND The objective of this multicentre r and omized , controlled clinical trial was to compare the efficacy of a levonorgestrel-releasing intrauterine system ( LNG-IUS ) and a depot-GnRH-analogue in the control of endometriosis-related pain over a period of six months . METHODS Eighty-two women , 18 to 40 years of age ( mean 30 years ) , with endometriosis , dysmenorrhoea and /or CPP , were r and omized using a computer-generated system of sealed envelopes into either LNG-IUS ( n = 39 ) or GnRH analogue ( n = 43 ) treatment groups at three university centres . Daily scores of endometriosis-associated CPP were evaluated using the Visual Analogue Scale ( VAS ) , daily bleeding score was calculated from bleeding calendars , and improvement in quality of life was evaluated using the Psychological General Well-Being Index Question naire ( PGWBI ) . The pain score diary was based on the VAS in which women recorded the occurrence and intensity of pain on a daily basis . A monthly score was calculated from the result of the sum of the daily scores divided by the number of days in each observation period . RESULTS CPP decreased significantly from the first month throughout the six months of therapy with both forms of treatment and there was no difference between the groups ( P > 0.999 ) . In both treatment groups , women with stage III and IV endometriosis showed a more rapid improvement in the VAS pain score than women with stage I and II of the disease ( P < 0.002 ) . LNG-IUS users had a higher bleeding score than GnRH-analogue users at all time points of observation with 34 % and 71 % of patients in the LNG-IUS and GnRH-analogue groups , respectively , reporting no bleeding during the first treatment month , and 70 % and 98 % reporting no bleeding during the sixth month . No difference was observed between groups with reference to improvement in quality of life . CONCLUSIONS Both , the LNG-IUS and the GnRH-analogue were effective in the treatment of CPP-associated endometriosis , although no differences were observed between the two treatments . Among the additional advantages of the LNG-IUS is the fact that it does not provoke hypoestrogenism and that it requires only one medical intervention for its introduction every 5 years . This device could therefore become the treatment of choice for CPP-associated endometriosis in women who do not wish to conceive INTRODUCTION Deep infiltrating endometriosis ( DIE ) is a form of endometriosis in which the lesion penetrates for more than 5 mm under the peritoneal surface . It is a chronic disease which can impair women 's sexual function . There is a growing body of evidence supporting combined surgical/medical treatment in the management of DIE . AIMS The aims of this article are to evaluate the impact of the laparoscopic full excision of endometriosis and postoperative combined oral contraceptives ( COC ) administration on sexual function in patients with DIE and to compare sexual function outcomes of women su bmi tted to intestinal resection and nodule excision .  METHODS It is a prospect i ve cohort study in a tertiary care university hospital on 106 sexually active women , with histologically confirmed DIE , managed by laparoscopy and subsequent COC therapy for 6 months . Patients filled preoperatively and 6-month postoperatively a quality of sexual life question naire , the Sexual Health Outcomes in Women Question naire ( SHOW-Q ) and they ranked their symptom intensity using a 10-point visual analogue scale ( VAS ) . MAIN OUTCOME MEASURES Sexual function was measured through the SHOW-Q scores and pain symptoms through VAS scores . Intraoperative details , type of intervention and perioperative complications were noted . RESULTS Six months after surgery and postoperative COC treatment , a significant improvement was observed in the SHOW-Q domains of pelvic problem interference , sexual satisfaction and desire ( P<0.05 ) . Laparoscopic management of DIE did not change significantly the orgasm area of the sexual functioning ( P=0.7 ) . No significant difference was found in SHOW-Q scores between patients su bmi tted to intestinal resection and patients su bmi tted to intestinal nodule excision ( P>0.05 ) . CONCLUSIONS Sexual desire , satisfaction with sex and pelvic problem interference with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative COC therapy . No difference in sexual outcomes was detected between patients su bmi tted to intestinal resection and nodule excision OBJECTIVE To assess the impact of endometriosis on health-related quality of life ( HRQoL ) and work productivity . DESIGN Multicenter cross-sectional study with prospect i ve recruitment . SETTING Sixteen clinical centers in ten countries . PATIENT(S ) A total of 1,418 premenopausal women , aged 18 - 45 years , without a previous surgical diagnosis of endometriosis , having laparoscopy to investigate symptoms or to be sterilized .  INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Diagnostic delay , HRQoL , and work productivity . RESULT ( S ) There was a delay of 6.7 years , principally in primary care , between onset of symptoms and a surgical diagnosis of endometriosis , which was longer in centers where women received predominantly state-funded health care ( 8.3 vs. 5.5 years ) . Delay was positively associated with the number of pelvic symptoms ( chronic pelvic pain , dysmenorrhoea , dyspareunia , and heavy periods ) and a higher body mass index . Physical HRQoL was significantly reduced in affected women compared with those with similar symptoms and no endometriosis . Each affected woman lost on average 10.8 hours ( SD 12.2 ) of work weekly , mainly owing to reduced effectiveness while working . Loss of work productivity translated into significant costs per woman/week , from US$ 4 in Nigeria to US$ 456 in Italy . CONCLUSION ( S ) Endometriosis impairs HRQoL and work productivity across countries and ethnicities , yet women continue to experience diagnostic delays in primary care . A higher index of suspicion is needed to expedite specialist assessment of symptomatic women . Future research should seek to clarify pain mechanisms in relation to endometriosis severity Background Deep infiltrating endometriosis ( DIE ) can affect importantly patients ' quality of life ( QOL ) . The aim of this study is to evaluate the impact of the laparoscopic management of DIE on QOL after six months from treatment . Methods It is a prospect i ve cohort study . In a tertiary care university hospital , between April 2008 and December 2009 , 100 patients underwent laparoscopic management of DIE  and completed preoperatively and 6-months postoperatively a QOL question naire , the short form 36 ( SF-36 ) . Quality of life was measured through the SF-36 scores . Intra-operative details of disease site , number of lesions , type of intervention , period of hospital stay and peri-operative complications were noted . Results Six months postoperatively all the women had a significant improvement in every scale of the SF-36 ( p < 0,0005 ) . Among patients with intestinal DIE , significant differences in postoperative scores of SF-36 were not detected between patients su bmi tted to nodule shaving and segmental resection ( p > 0.05 ) . There was no significant difference in the SF-36 scores at 6 months from surgery between patients who received postoperative medical treatment and patients who did not ( p > 0.05 ) . Conclusions Laparoscopic excision of DIE lesions significantly improves general health and psycho-emotional status at six months from surgery without differences between patients su bmi tted to intestinal segmental resection or intestinal nodule shaving BACKGROUND This pilot study evaluates the efficacy of norethisterone acetate in treating pain and gastrointestinal symptoms of women with colorectal endometriosis . METHODS This prospect i ve study included 40 women with colorectal endometriosis , who had pain and gastrointestinal symptoms . Patients received norethisterone acetate ( 2.5 mg/day ) for 12 months ; in case of breakthrough bleeding , the dose of norethisterone acetate was increased by 2.5 mg/day . The degree of patient satisfaction with treatment ( primary end-point ) and the changes in symptoms ( secondary end-point ) were evaluated . Side effects of treatment were recorded . RESULTS Norethisterone acetate determined a significant improvement in the intensity of chronic pelvic pain , deep dyspareunia , dyschezia . Treatment determined the disappearance of symptoms related to the menstrual cycle ( dysmenorrhea , constipation during the menstrual cycle , diarrhoea during the menstrual cycle and cyclical rectal bleeding ) . The severity of diarrhoea , intestinal cramping and passage of mucus significantly improved during treatment . On the contrary , the administration of norethisterone acetate did not determine a significant effect on constipation , abdominal bloating and feeling of incomplete evacuation after bowel movements . At the completion of treatment , 57 % of the patients with diarrhoea or diarrhoea during the menstrual cycle continued the treatment with norethisterone acetate compared with 17 % of the patients with constipation or constipation during the menstrual cycle . CONCLUSIONS In some patients with bowel endometriosis , the administration of norethisterone acetate may determine a relief of pain and gastrointestinal symptoms . This therapy has greater benefits in patients with gastrointestinal symptoms related to the menstrual cycle , diarrhoea and intestinal cramping Objective . Limited attention has been focused on the medical treatment of bowel endometriosis . This study evaluates the efficacy of administration of a continuous low‐dose oral contraceptive in treating pain and other symptoms associated with colorectal endometriotic nodules , as evaluated by rectal endoscopic ultrasonography . Design . Prospect i ve observational study . Setting . Academic Department of San Raffaele Scientific Institute , Obstetrics and Gynecology Unit . Population . Symptomatic women of reproductive age ( n=26 ) with colorectal nodules infiltrating at least the bowel muscularis propria and without a stenosis > 50 % . In 31 % of the patients , endoscopic ultrasonography permitted diagnosis of nodules located more than 10 cm from the anal rim . Methods . Patients received a continuous low‐dose oral contraceptive containing 15 μg ethinylestradiol and 60 μg gestodene for 12 months . Subjective symptoms were prospect ively evaluated , and nodule volumes were monitored using endoscopic ultrasonography . Main outcome measures . Nodule measurements were performed at baseline and after 12 months of treatment . Symptoms at the start and after 12 months were evaluated . Results . A significant improvement in the intensity of all the considered symptoms ( dysmenorrhea , non‐menstrual pelvic pain , deep dyspareunia and painful defecation ) was seen when evaluated by a visual analog scale . A reduction in terms of both diameter ( mean reduction 26 % ) and volume of the nodules ( mean reduction 62 % ) was observed after a 12 month period . Conclusions . A continuous low‐dose oral contraceptive therapy may reduce bowel endometriosis‐associated symptoms . In addition , this therapy induces a significant volumetric reduction of colorectal plaques when evaluated by endoscopic ultrasonography BACKGROUND This study investigates the outcomes for women up to 5 years after laparoscopic excision of endometriosis . METHODS In this prospect i ve observational cohort study , 254 women with chronic pelvic pain were referred to two units specializing in minimal access surgical management of endometriosis . Of these , 216 women underwent surgical assessment and 176 were confirmed to have endometriosis .  Question naires and visual analogue scale ( VAS ) scores for dysmenorrhoea , non-menstrual pelvic pain , dyspareunia and dyschesia as well as quality of life instruments ; the EQ-5Dindex and  EQ-5Dvas  ,  Short-Form 12 ( SF-12 ) and  sexual activity question naires were completed pre-operatively . Intra-operative details of revised American Fertility Society ( rAFS ) stage , site of disease , associated tests , duration of surgery and complications were noted . Follow-up was performed by postal question naire and chart review . For women who had further surgery , rAFS stage , site of disease , other procedures and histology were all recorded . RESULTS Pain scores were all significantly reduced at 2 - 5 years for dysmenorrhoea ( median VAS baseline versus follow-up 2 - 5 years ) ; 9 versus 3.3 ( P < 0.0001 ) , non-menstrual pelvic pain 8 versus 3 ( P < 0.0001 ) , dyspareunia 7 versus 0 ( P < 0.0001 ) and dyschesia 7 versus 2 ( P < 0.0001 ) . Quality of life was improved for the EQ-5Dindex ( P = 0.008 and the EQ-5Qvas ( P = 0.03 ) and for sexual function with pleasure ( P = 0.001 ) and habit ( P = 0.012 ) being improved and discomfort being decreased ( P = 0.001 ) . The chance of requiring further surgery as determined by the Kaplan-Meier survival curve was 36 % . A rAFS score of > 70 was predictive of requiring further surgery ( P = 0.03 ) . Of women who had further surgery , endometriosis was found histologically in 68 % . CONCLUSIONS Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life for up to 5 years . The probability of requiring further surgery is 36 % . Return of pain following laparoscopic excision is not always associated with clinical evidence of recurrence BACKGROUND This study aim ed to calculate costs and health-related quality of life of women with endometriosis-associated symptoms treated in referral centres . METHODS A prospect i ve , multi-centre , question naire-based survey measured costs and quality of life in ambulatory care and in 12 tertiary care centres in 10 countries . The study enrolled women with a diagnosis of endometriosis and with at least one centre-specific contact related to endometriosis-associated symptoms in 2008 . The main outcome measures were health care costs , costs of productivity loss , total costs and quality -adjusted life years . Predictors of costs were identified using regression analysis . RESULTS Data analysis of 909 women demonstrated that the average annual total cost per woman was € 9579 ( 95 % confidence interval € 8559-€10 599 ) . Costs of productivity loss of € 6298 per woman were double the health care costs of € 3113 per woman . Health care costs were mainly due to surgery ( 29 % ) , monitoring tests ( 19 % ) and hospitalization ( 18 % ) and physician visits ( 16 % ) . Endometriosis-associated symptoms generated 0.809 quality -adjusted life years per woman . Decreased quality of life was the most important predictor of direct health care and total costs . Costs were greater with increasing severity of endometriosis , presence of pelvic pain , presence of infertility and a higher number of years since diagnosis . CONCLUSIONS Our study invited women to report re source use based on endometriosis-associated symptoms only , rather than drawing on a control population of women without endometriosis . Our study showed that the economic burden associated with endometriosis treated in referral centres is high and is similar to other chronic diseases ( diabetes , Crohn 's disease , rheumatoid arthritis ) . It arises predominantly from productivity loss , and is predicted by decreased quality of life OBJECTIVE To compare the efficacy of leuprolide and continuous oral contraceptives in the treatment of endometriosis-associated pain . DESIGN Prospect i ve , r and omized , double-blind controlled trial . SETTING Academic medical centers in Rochester , New York , and Boston , Massachusetts . PATIENT(S ) Forty-seven women with endometriosis-associated pelvic pain . INTERVENTION(S ) Forty-eight weeks of either depot leuprolide , 11.25 mg IM every 12 weeks with hormonal add-back using norethindrone acetate 5 mg orally , daily ; or a generic monophasic oral contraceptive ( 1 mg norethindrone + 35 mg ethinyl estradiol ) given daily . MAIN OUTCOME MEASURE(S ) Biberoglu and Behrman ( B&B ) pain scores , numerical rating scores ( NRS ) , Beck Depression Inventory ( BDI ) , and Index of Sexual Satisfaction ( ISS ) . RESULT ( S ) Based on enrollment of 47 women r and omized to continuous oral contraceptives and to leuprolide , there were statistically significant declines in B&B , NRS , and BDI scores from baseline in both groups . There were no significant differences , however , in the extent of reduction in these measures between the groups . CONCLUSION ( S ) Leuprolide and continuous oral contraceptives appear to be equally effective in the treatment of endometriosis-associated pelvic pain STUDY OBJECTIVE To describe the effect of fertility-sparing laparoscopic excision of endometriosis and bowel resection on clinical and quality -of-life outcomes . DESIGN Prospect i ve observational cohort study ( Canadian Task Force classification II-2 ) . SETTING Australian tertiary referral center for the surgical treatment of endometriosis . PATIENTS Seven consecutive patients with known endometriosis involving the bowel . INTERVENTION Laparoscopic resection of all endometriosis , including laparoscopic bowel resection with end-to-end anastomosis with or without temporary ileostomy . MEASUREMENTS AND MAIN RESULTS Preoperative and 12-month postoperative data were collected by use of visual analogue scores for dysmenorrhea , nonmenstrual pelvic pain , dyspareunia , and dyschezia . Vali date d research tools ( SF12 , EuroQOL , and Sexual Activity Question naire ) also assessed quality of life . Reduction in median pain scores at baseline was demonstrated and at 12 months after operation for dysmenorrhea 71 ( interquartile range 43 - 85 ) versus 5 ( 0 - 10 ) ; p=.028 , nonmenstrual pelvic pain 74 ( 48 - 85 ) versus 11 ( 0 - 18 ) ; p=.046 , dyspareunia 66 ( 0 - 98 ) versus 5 ( 0 - 8 ) ; p=.080 , and dyschezia 48 ( 20 - 64 ) versus 20 ( 0 - 40 ) ; p=.173 . All measures of quality of life were improved at 12 months after surgery , although not reaching statistical significance because of the small sample size . All three women wishing to conceive after operation have been successful , result ing in three live births at term . There were few complications associated with this surgery . CONCLUSION Fertility-sparing laparoscopic excision of endometriosis with bowel resection results in improvements in all aspects of pain and quality of life . Results appear to parallel published data for conservative resection of endometriosis not involving bowel . For women with severe endometriosis involving bowel , this surgical treatment provides a viable alternative to pelvic clearance and successfully maintains fertility BACKGROUND The available data on effectiveness of aromatase inhibitors in treating pain symptoms  related to endometriosis is limited . We compared the efficacy and tolerability of the aromatase inhibitor letrozole combined with norethisterone acetate versus norethisterone acetate alone in treating pain symptoms . METHODS This prospect i ve , open-label , non-r and omized trial included 82 women with pain symptoms caused by rectovaginal endometriosis . Patients received either a combination of letrozole and norethisterone acetate ( group L ) or norethisterone acetate alone ( group N ) for 6 months . Changes in pain symptoms during treatment and in the 12 months of follow-up were evaluated . Side effects of each treatment protocol were recorded . RESULTS Intensity of chronic pelvic pain and deep dyspareunia significantly decreased during treatment ( P < 0.001 versus baseline by 3 months ) in both study groups . At both 3- and 6-month assessment , the intensity of chronic pelvic pain ( P < 0.001 , P = 0.002 , respectively ) and deep dyspareunia ( P < 0.001 , P = 0.005 , respectively ) was significantly lower in group L than group N. At completion of treatment , 63.4 % of women in group N were satisfied with treatment compared with 56.1 % in group L ( P = 0.49 ) . Pain symptoms recurred after the completion of treatment ; at 6-month follow-up no difference was observed in the intensity of pain symptoms between the groups . Adverse effects were more frequent in group L than in group N ( P = 0.02 ) . CONCLUSIONS The combination drug regimen was more effective in reducing pain and deep dyspareunia than norethisterone acetate ; however , letrozole caused a higher incidence of adverse effects , cost more and did not improve patients ' satisfaction or influence recurrence of pain STUDY OBJECTIVE To estimate the quality of life of patients undergoing laparoscopic resection of a segment of the rectosigmoid for the treatment of deep infiltrating endometriosis with bowel involvement . DESIGN Prospect i ve application of the SF-36 Health Status Question naire to 151 women before and 1 year after surgical intervention ( Canadian Task Force Design Classification II ) . SETTING Department of Obstetrics and Gynecology , University of São Paulo Medical School , and Samaritano Hospital , São Paulo , Brazil . PATIENTS A total of 151 women ( mean age 34.05 ± 5.65 years ) with deep infiltrating endometriosis underwent resection of a segment of the rectosigmoid by laparoscopy between 2002 to 2009 . INTERVENTIONS All the patients had historical data collected and underwent clinical examination and transvaginal ultrasonography with prior bowel preparation for resection of a segment of the rectosigmoid by laparoscopy indicated for patients with symptoms ( pelvic pain ) with 1 or more lesions of more than 3 cm in length or multifocal lesions . MEASUREMENTS AND MAIN RESULTS Wilcoxon signed rank test verified differences between the degrees of the symptoms and the SF-36 scores before and 1 year after laparoscopic treatment . There was a significant improvement ( p < .001 ) in all pain-related symptoms , as well as a significant increase ( p < .001 ) in scores in all the SF-36 domains and in the sum of the components comprising both physical and mental health . CONCLUSION Laparoscopic segmental resection of the rectosigmoid fulfills its essential objective of treating endometriosis with bowel involvement and improving patients ' QoL to a significant extent OBJECTIVE The purpose of this study was a quantification of changes in endometriosis-associated  pain and quality of life during the stimulatory phase of gonadotropin-releasing hormone agonist therapy . STUDY DESIGN One hundred twenty women with significant endometriosis-associated pain participated in a 1-month double-blind , r and omized , placebo-controlled trial . Pain was measured at baseline and at 2 and 4 weeks with  visual analog scales  and the Endometriosis Symptom Severity score . Quality of life was measured with the SF-36 instrument . Group means and SEMs were calculated . Paired t tests were used after determination of data normality . RESULTS Compared with placebo-treated control subjects women treated with gonadotropin-releasing hormone agonist had a statistically ( P < . 0001 ) and clinical ly significant temporary increase in pain and a concomitant decrease in quality of life . CONCLUSION The stimulatory phase of gonadotropin-releasing hormone agonist therapy is associated with an increase in endometriosis-associated pain and a decrease in quality of life Objective . To evaluate sexual function , quality of life and pelvic pain after  endometriosis surgery including vaginal resection .  Design . Prospect i ve observational study with 12 months follow up . Setting . Regional central hospital and university hospital . Population . Twenty‐two patients with deep endometriotic nodules in the posterior fornix of the vagina undergoing complete excision of endometriosis , including vaginal resection .  Methods . Sexual functioning was measured with the  McCoy Female Sexuality Question naire , quality of life  with a generic question naire  ( 15D )  and  pain  with a  10‐point visual analog scale  . Question naires were completed before and 12 months after the surgery . Main outcome measures . Changes in sexual function scores , quality ‐of‐life scores and pain . Results . Twelve months after surgery , the sexual satisfaction score was higher ( p= 0.03 ) and the sexual problems score lower ( p= 0.04 ) compared with baseline values . Health‐related quality ‐of‐life scores for discomfort and symptoms ( p= 0.001 ) , distress ( p= 0.04 ) , vitality ( p= 0.03 ) and sexual activity ( p= 0.001 ) , and the overall 15D score ( p < 0.001 ) , were significantly improved . The severity of all studied types of pain was significantly decreased ( p < 0.05 ) . Conclusions . Complete excision of endometriosis , including vaginal resection , seems to offer a significant improvement in sexual functioning , quality of life and pelvic pain in symptomatic patients with deeply infiltrating endometriotic nodules in the posterior fornix of the vagina . This surgery may be associated with complications and adverse new‐onset symptoms , and should be performed only after thorough consultation with the patient BACKGROUND Implanon has been reported to be effective in the treatment of dysmenorrhea . We compared the therapeutic efficacies of depot medroxyprogesterone acetate ( DMPA ) and Implanon with regard to pain relief in women with endometriosis . STUDY DESIGN In a clinical research center at a university hospital , 41 patients with dysmenorrhea , nonmenstrual pelvic pain and dyspareunia associated with histologically proven endometriosis were included in an open , prospect i ve , r and omized , controlled clinical trial . Twenty-one women were assigned by computer-generated r and omization to receive  Implanon , and 20 women to receive DMPA . As main outcome measures of this pilot study , we evaluated pain improvement quantified according to visual analog scale score , side effects , vaginal bleeding patterns , withdrawal rate and overall degree of satisfaction . RESULTS During a follow-up period of 1 year , we ascertained a clear improvement in pain intensity for both treatment options . After 6 months , the average decrease in pain was 68 % in the Implanon group and 53 % in the DMPA group . The side-effects profile and the overall degree of satisfaction after study termination were comparable for both treatment options . CONCLUSION Concerning pain relief , the therapeutic efficacy of the contraceptive implant Implanon is not inferior to that of DMPA in symptomatic endometriosis
target: Surgery and the use of drugs provided reduced pain scores in patients with endometriosis but nevertheless exhibit disadvantages , such as risk of recurrence and side effects , respectively .
  However , improved quality of life in these patients has been obtained with the use of conventional treatment
background: Endometriosis is a chronic gynecological disease characterized by sustained painful symptoms that are responsible for a decline in the quality of life of sufferers .
  Conventional treatment includes surgical and pharmacological therapy aim ing at reducing painful symptoms .
  This study aim ed to evaluate pain levels in women with endometriosis , focusing on the influence of conventional treatment in controlling this variable .
  Treatment of endometriosis is , therefore , a challenge for gynecologists and patients , as they must select the best therapeutic approach for this disease .