Are gonadotropin-releasing hormone analogs and laparoscopic ablation equally effective treatments for endometriosis?

Abstract

Endometriosis is a disease of the female reproductive system in which endometrial tissue exists outside of the uterus and is found attached to other organs. Although both laparoscopic ablation and gonadotropin-releasing hormone analogs (GnRHa) are treatments for endometriosis, there are no studies that directly compare these two treatment options.

Purpose: Through a systemic review of evidence-based literature with the purpose of making recommendations for treatment, this study compares the use of GnRHa therapy and laparoscopic ablation concerning symptom relief, recurrence of symptoms, safety, short and long-term side effects of treatment and overall improvement of quality of life in women ages 18-50 with diagnosed endometriosis.

Methods: The study design is an evidence-based literature review, assessing each study for its level of evidence, research design, inclusion and exclusion criteria, treatment results, adverse affects and conclusions. Results: All but one research study showed that GnRHa are effective at improving quality of life by relieving endometriosis symptoms for varying lengths of time, lasting up to one year post treatment. Side effects were consistent with hypoestrogenemia and were non-life threatening. Surgical treatment by laparoscopic ablation was found to successfully treat endometriosis symptoms, but fertility rates were not consistently improved. Adhesion formation was a complication of surgery, but was found to correlate to the presence of adhesions prior to surgery.

Conclusions: There are many factors that are necessary to consider when determining the best therapy including quality of symptoms, extent of endometriosis determined laparoscopically, age of patient and patient preference. Both GnRHa and laparoscopic ablation are safe, reduce symptoms and improve the overall quality of life, therefore more research is needed in order to determine specificparameters for each treatment.