Cyproterone or OCs effective for recurrent pelvic pain after endometriosis surgery

NEW YORK (Reuters Health) – A daily low dose of cyproterone acetate or a continuous monophasic oral contraceptive (OC) are both good options for the treatment of recurrent pelvic pain after conservative surgery for symptomatic endometriosis, according to results of a randomized, controlled comparative trial.

In the January issue of Fertility and Sterility, Dr. Paolo Vercellini, of the University of Milan, and colleagues note that daily oral cyproterone acetate at a dose of 27 mg combined with 0.035 mg ethinyl estradiol is efficacious in women with endometriosis. Anecdotal evidence gathered by the team suggests that halving the dose of cyproterone and eliminating the estradiol is possible without compromising efficacy.

To investigate, they evaluated the efficacy and safety of oral cyproterone acetate, 12.5 mg/d versus an OC containing ethinyl estradiol, 0.02 mg and desogestrel 0.15 mg in 90 women with recurrent moderate or severe pelvic pain after endometriosis surgery.

Both regimens were effective and well tolerated and were associated with "appreciable improvements of health-related quality-of-life, psychoemotional status, and sexual satisfaction." These measures were slightly higher in the cyproterone acetate group.

Six cyproterone-treated subjects and nine OC-treated subjects did not complete the 6-month trial–nine withdrew due to side effects, four due to treatment inefficacy, and two were lost to follow-up.

In an intention-to-treat analysis, in which subjects who withdrew were counted as treatment failures, 73% of cyproterone acetate-treated subjects and 67% of OC-treated subjects were satisfied with the treatment they received.

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