Table 1 Characteristics and outcomes of the included studies evaluating the effect of the medical treatment for endometriosis on QoL
First author and study period | Type of study | Sample size | Range of age | Type of medical treatment | Type of endometriosis treated | Results | Instruments |
|---|---|---|---|---|---|---|---|
Ács et al. 2015 [50] | Multicenter randomized controlled study | 180 n = 45 Oral elagolix 150 mg once daily n = 45 Elagolix 250 mg n = 45 placebo n = 45 LA 1-month depot 3.75 mg intramuscularly | 18-45 | GnRH antagonist: Elagolix vs leuprorelin acetate (LA) and placebo | Not specified | There were improvements from baseline to week 12 in all 5 dimensions of the EHP-5 in all treatment groups. The differences between elagolix 150 mg, elagolix 250 mg vs. LA were statistically significant (p = 0.006 and p = 0.0204, respectively), which indicated a higher efficacy of LA in the pain dimension of EHP-5. | EHP-5 |
Agarwal et al. 2015 [47] | Randomized, multicenter, open-label clinical trial | 20 n = 5 D + E2 transdermal n = 7 D + E2 nasal n = 8 D + E2 + T nasal | 25-45 | Gonadotropin-releasing hormone agonist (GnRHa) deslorelin (D) with low-dose estradiol ± testosterone (E2 ± T) add-back | Not specified | There were statistically significant improvements relative to baseline for five of the ten quality of life domains: physical functioning, role physical, bodily pain, social functioning, and vitality; those that were unaffected by treatment were already within normative ranges for women of similar age at baseline. Quality of life issues with everyday problems was significantly improved with treatment. | SF-36 |
Caruso et al. 2015 [51] | Prospective study | 92 | 18-37 | Dienogest | Not specified | At 3 months follow-up, women reported QoL improvement in physical function, physical role, body pain, general health, social function and emotional role categories (p < 0.05); at 6 months follow-up, they reported improvement in all categories (p < 0.001). | SF-36 |
Caruso et al. 2015 [63] | Prospective study | 56 | 18-31 | Palmitoylethanolamine and α-lipocic acid | Not specified | No changes were observed in QoL at the 3rd month follow-up. By the 6th and 9th month all categories of the QoL (P < 0.001) improved. | SF-36 |
Caruso et al. 2016 [57] | Comparative, open-label prospective study | 96 n = 63 Study group (continuous regimen) n = 33 Control group (21/7 regimen) | 18-35 | 2 mg dienogest/30 μg ethinyl estradiol continuous vs 21/7 regimen oral contraceptive | Not specified | At 3 and 6 months, the Study group reported QoL improvements in all categories (p < 0.001). The Control group reported QoL improvements in all categories at the second follow-up (p < 0.05). The QoL of the Control group improved slightly at the second follow-up. The intergroup statistical comparison analysis between each follow-up showed a better efficacy of the continuous regimen than the 21/7 conventional regimen in all the QoL aspects. | SF-36 |
Carvalho et al. 2018 [62] | Randomized clinical trial | 103 n = 52 ENG implant n = 51 LNG-IUS | 18-35 | Etonogestrel-releasing contraceptive implant vs 52 mg levonorgestrel-releasing intrauterine system | Not specified | Health-related quality of life improved significantly in all domains of the core and modular segments of the Endometriosis Health Profile-30 questionnaire, with no difference between both treatment groups. | EHP-30 |
Granese et al. 2015 [49] | Multi-center randomized trial | 78 n = 39 Dienogest + E2V n = 39 GnRH-a | 18-45 | Gonadotrophin-releasing hormone analog vs dienogest plus estradiol valerate after laparoscopic surgery for endometriosis | Not specified | At the 9-month follow up, the questionnaire results showed a considerable increase of scores for all women compared with before surgery, demonstrating an improvement in the QoL and an equal health-related satisfaction with both treatments | EHP-5 |
Lee et al. 2016 [48] | Prospective, comparative study | 64 n = 28 GnRHa + add back group n = 36 Dienogest group | 18-45 | GnRHa plus add back therapy vs dienogest in the treatment of pain recurrences after laparoscopic surgery for endometriosis | Not specified | In this study, there are no differences in QOL according to treatment option. | WHOQOL-BREF |
Leonardo-Pinto et al. 2017 [55] | Prospective cohort study | 30 | 18-45 | Dienogest | DIE (intestinal and posterior fornix) | Treatment with dienogest for 12 months positively affected several domains of QoL, with significant improvement in the physical, psychological, as well as a self-assessment of QoL and health. | WHOQOL-BREF |
Luisi et al. 2015 [52] | Prospective observational multicenter cohort study | 142 | Dienogest | Not specified | Quality-of-life assessments in the present study showed improvements in both physical and mental indices within 12 weeks, also confirming the decrease of endometriosis-associated pain. | SF-12 | |
Morotti et al. 2014 [58] | Prospective patient preference trial | 144 n = 82 COC group n = 62 Desogestrel group | COCs vs POPs in patients with migraine without aura | Symptomatic rectovaginal endometriosis and migraine without aura | Regarding the quality of life, the baseline values of physical component summary (PCS) and mental component summary (MCS) were similar for both groups while after 6 months of treatment a statistical improvement was observed in both components in group POP (p < 0.001 for both PCS and MCS) compared to group COC (p = 0.154 and p = 0.640 for PCS and MCS respectively) | SF-36 | |
Sansone et al. 2018 [61] | Multicenter prospective observational study | 25 | 18-45 | Etonogestrel implant | Ovarian endometrioma | After 12 months, the bodily pain, general health, vitality, social functioning, and mental health domains of the QoL score were significantly improved. | SF-36 |
Seo Jong-Wook 2019 [56] | Prospective cohort study | 52 women n = 20 GnRHA+ COC n = 32 Dienogest (28.1 5.9) | Combined oral contraceptive (COC) after gonadotropin-releasing hormone (GnRH) agonist plus add-back therapy vs dienogest (DNG) treatment as medical treatments after surgery | Ovarian endometrioma | Physical, psychological, social, and environmental components of QOL were not significantly different across treatment options. | WHOQOL-BREF | |
Strowitzki et al. 2010 [53] | Randomized, double-blind, placebo-controlled study | 188 n = 90 Placebo n = 98 Dienogest | 18-45 | Dienogest at a dose of 2 mg daily for 12 weeks | Not specified | Quality-of-life analyses indicated greater improvements in the dienogest group for two of eight SF-36 categories: bodily pain and role emotional Mental sum scale and physical sum scale scores showed similar improvements in both groups. | SF-36 |
Strowitzki et al. 2010 [54] | Randomized, multicenter, open-label trial | 186 n = 90 DNG group n = 96 LA group | 18-45 | Dienogest vs leuprolide acetate for 24 weeks | Not specified | Compared with LA, DNG was associated with pronounced improvements in specific quality-of-life measures. In particular, DNG produced greater improvements in the categories “physical functioning,” “vitality,” and “social functioning.” | SF-36 |
Tanmahasamut et al. 2012 [59] | Double-blind randomized controlled trial | 54 n = 28 Levonorgestrel-releasing intrauterine system n = 26 Control group | Postoperative Levonorgestrel-releasing intrauterine system | Not specified | The Short Form-36 scores improved in the levonorgestrel-releasing intrauterine system group but did not change in the expectant management group | SF-36 | |
Yucel et al. 2018 [60] | Prospective, cross-sectional and non-comparative study | 42 | 18-50 | Levonorgestrel-releasing intrauterine system | Not specified | Regarding the SF-36 health questionnaire, the calculated physical health scores and the mental health scores increased by the end of 12 months. | SF-36 |
Zhao et al. 2012 [46] | Controlled, randomized, open-label study | 100 n = 50 GnRHa +PMR n = 50 Control group: only GnRHa therapy | 18-48 | Progressive muscle relaxation training on patients under GnRHa | Not specified | After 12 weeks of therapy with gonadotrophin-releasing hormone agonists (GnRHa), women with endometriosis experienced improvement in almost all QoL parameter. Between-group comparisons of the improvement in scores after intervention showed that the PMR group had significantly better improvement in the scores of anxiety, depression and overall/domain QOL than the control group (P < 0.05) | SF-36 |