In a randomised controlled multicentre trial (DOI. 10.1136/bmj-2023-079006) from the UK, researchers investigated whether COCs or long-acting progestins were better suited to prevent postoperative pain from endometriosis. They recruited around 400 women from 34 gynaecological clinics. All of them had already undergone surgery and were randomised 1:1 into two groups:
The primary endpoint was pain, which was assessed three years after randomisation using a specific questionnaire. The Endometriosis Health Profile 30 (EHP-30) is a validated instrument for assessing the quality of life of endometriosis patients and, in addition to pain, also records other parameters such as control and powerlessness, emotional well-being, work, and sexual relationships. It also includes treatment failure (further therapeutic interventions or second-line medical treatment).
After three years, pain scores in both groups had improved by an average of around 40% compared to preoperative scores. There was no statistically significant difference between COCs and long-acting progestins. Most other areas of the EHP-30 were also positively influenced by the treatment, again independently of the active ingredients.
However, the hormone therapies differed in one outcome: women in the progestogen group had 33% fewer surgeries or other follow-up treatments than women in the COC group.
The study shows that (in line with guideline recommendations) postoperative hormone therapy for endometriosis contributes to long-term pain reduction. Long-acting progestins may reduce the risk of re-operation, possibly combined with hysterectomy, even better than the pill.
The researchers see yet another advantage in the depot preparations and IUS: they need to be administered less frequently and could thus improve adherence. This aspect should be taken into account when advising the women concerned.
One thing is clear: endometriosis is a chronic disease that is often associated with a high level of morbidity and a reduced quality of life. This makes it all the more important to have a long-term effective therapy with as few follow-up treatments as possible.