Title

In females with endometriosis, are medications that affect GnRH more effective at treatment of pain than oral contraceptives or NSAIDs?

Date of Award

Spring 2021

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Allison Ermol

Abstract

Introduction: Endometriosis is a gynecological condition that affects females of reproductive age, and 50% of women with infertility. This condition is characterized by growth of endometrial-like tissue outside of the uterus, and can cause dysmenorrhea, pelvic pain, and dyspareunia. The standard first line medications include oral contraceptive pills—which aim to suppress ovulation and menses—used in combination with NSAIDs. If pharmacological therapy fails and patients still experience pain, surgical intervention is often necessary. However, many patients still experience pain regardless of these therapies, so it is important to explore other treatment options. Newer pharmacologic agents that affect the gonadotropin releasing hormone (GnRH) receptors have been developed specifically to treat endometriosis associated symptoms. Thus, this paper poses the following question: in females with endometriosis [P], are medications that affect GnRH receptors [I] more effective at treatment of pain [O] than oral contraceptives or NSAIDs [C]?

Methods: A literature search was conducted through the Pennsylvania State University Libraries and PubMed in November 2019. After this search five articles were chosen based on their relevance to the PICO question, year of publication, study design, and outcome measurements. The results of these articles were then compared.

Results: Of the five studies analyzed in this paper, only one study directly compared the use of GnRH medications to oral contraceptive pills. Two studies compared GnRH medications to placebo, one compared oral contraceptive pills to NSAIDs, and one looked at the long-term effects of GnRH medications. While the focus of each article was different, all evaluated at least one of the following outcomes: improvement in dysmenorrhea, non-menstrual pelvic pain, or dyspareunia. The results indicate that GnRH medications do improve endometriosis related pain, but the benefit over OCPs was not statistically significant.

Discussion: Positive results were found for the intervention being looked at in each article, however they showed no significant difference between GnRH medications and OCPs. The blinding, timeline, and follow up were found to be “adequate” for the majority of the articles, while potential biases were found to be “moderate” for the majority of the articles. In the future, more studies directly comparing GnRH medications and OCPs, longer timelines, and less potential observer bias should be utilized to improve the body of research in this area.

Conclusion: The studies looking at GnRH medications had positive results—all indicated that they reduce endometriosis related pain. However, one study does not show benefit of these medications over OCPs—it indicated that both had comparable efficacy in treating endometriosis related pain. Another study showed negative long-term health effects of these medications. The results from these studies as a whole do not seem to support the use of GnRH medications over OCPs, and the risks do not seem to outweigh the benefits. Since research in this area is limited, future research should focus on directly comparing GnRH medications and OCPs to address the efficacy of the two.

Additional Files

Poster Presentation - Emily Ratay.pdf (2519 kB)

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In females with endometriosis, are medications that affect GnRH more effective at treatment of pain than oral contraceptives or NSAIDs?

Introduction: Endometriosis is a gynecological condition that affects females of reproductive age, and 50% of women with infertility. This condition is characterized by growth of endometrial-like tissue outside of the uterus, and can cause dysmenorrhea, pelvic pain, and dyspareunia. The standard first line medications include oral contraceptive pills—which aim to suppress ovulation and menses—used in combination with NSAIDs. If pharmacological therapy fails and patients still experience pain, surgical intervention is often necessary. However, many patients still experience pain regardless of these therapies, so it is important to explore other treatment options. Newer pharmacologic agents that affect the gonadotropin releasing hormone (GnRH) receptors have been developed specifically to treat endometriosis associated symptoms. Thus, this paper poses the following question: in females with endometriosis [P], are medications that affect GnRH receptors [I] more effective at treatment of pain [O] than oral contraceptives or NSAIDs [C]?

Methods: A literature search was conducted through the Pennsylvania State University Libraries and PubMed in November 2019. After this search five articles were chosen based on their relevance to the PICO question, year of publication, study design, and outcome measurements. The results of these articles were then compared.

Results: Of the five studies analyzed in this paper, only one study directly compared the use of GnRH medications to oral contraceptive pills. Two studies compared GnRH medications to placebo, one compared oral contraceptive pills to NSAIDs, and one looked at the long-term effects of GnRH medications. While the focus of each article was different, all evaluated at least one of the following outcomes: improvement in dysmenorrhea, non-menstrual pelvic pain, or dyspareunia. The results indicate that GnRH medications do improve endometriosis related pain, but the benefit over OCPs was not statistically significant.

Discussion: Positive results were found for the intervention being looked at in each article, however they showed no significant difference between GnRH medications and OCPs. The blinding, timeline, and follow up were found to be “adequate” for the majority of the articles, while potential biases were found to be “moderate” for the majority of the articles. In the future, more studies directly comparing GnRH medications and OCPs, longer timelines, and less potential observer bias should be utilized to improve the body of research in this area.

Conclusion: The studies looking at GnRH medications had positive results—all indicated that they reduce endometriosis related pain. However, one study does not show benefit of these medications over OCPs—it indicated that both had comparable efficacy in treating endometriosis related pain. Another study showed negative long-term health effects of these medications. The results from these studies as a whole do not seem to support the use of GnRH medications over OCPs, and the risks do not seem to outweigh the benefits. Since research in this area is limited, future research should focus on directly comparing GnRH medications and OCPs to address the efficacy of the two.