A Cochrane review [Abstract] 1 included 2 studies with a total of 193 subjects. One trial compared the nonstop transdermal 17β-estradiol (0.05 mg/day) combined with cyclic medroxy progesterone acetate (10 mg per day) for 12 days per month (E+P arm) in women with a conserved uterus with nonstop tibolone 2.5 mg/day (tibolone arm). The second trial compared estrogen with or without progesterone (2 patches of estrogen weekly with a release of 0.05 mg/day with or without progesterone 200 mg/day orally for 14 days with a 16-day interval free of treatment) with no treatment. The pain recurred in 4/10 of women E+P arm compared with 1/11 in the tibilone arm (OR 6.67, 95% CI 0.60 to 74.51), and in 4/115 women in the other estrogen (plus progesterone) treatment group vs 0/57 patients in the no-treatment group (OR 4.64, 95% CI 0.25 to 87.71). Neither finding was statistically different. The second trial found that 2/115 of the treatment group developed recurrence of endometriosis and were re-operated compared with 0/57 in the no-treatment group (OR 2.53, 95% CI 0.12 to 53.64, non-significant).
Comment: The quality of evidence is downgraded by study quality (lack of blinding), by imprecise results (few patients and wide confidence intervals), and by potential reporting bias (only 2 small trials reported).
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