To be or not to be [surgery or hormonal therapies for pain] that’s the question!

Which one is more effective, hormonal therapies, surgery, or pills after surgery for proper pain management?

Key Points

Highlights:

• The authors questioned whether it is worth having surgery, or is it effective to continue hormonal medications even after surgery.

Importance:

• The results of the study revealed the equal effects of having hormonal medications and surgery, but a superiority of combining both on DIE management.
• The surgical treatment proved to be more effective and more enduring at improving chronic pelvic pain, dyschezia, and deep dyspareunia.

What's done here:

• 122 women have been selected using a retrospective convenience sampling method from patient archives.
• According to the hospital’s protocol, all women who had surgery had at least 6 months of hormone-based treatment and the pain management has been failed.
• After surgery, some of the patients continued hormonal treatment while the rest have not and those who had hormonal therapies have been counted as the third group.
• The control group has been defined as the women who are on hormonal therapy for 6 months and did not have surgery. 
• The pain was scaled by using the VAS scale with Deep Dyspareunia Scale and baseline numbers have been evaluated as at the time of surgery for the surgery group, and at the beginning of hormonal treatment for the control group.

Key Results:

• Both approaches have been found to be effective to reduce pain.
• For deep pain, dyspareunia, and dyschezia, surgery was significantly more effective than medication alone.
• The only parameter that continuing hormonal treatment after surgery reduces was dysuria.

Limitations:

• The retrospective nature of the study came with limitations on the study design. As the surgery group had also been treated with hormonal therapies and failed to proceed, it raises an opinion that there should be heterogeneity in the patient characteristics when compared with the control group who continued hormonal medications.

Lay Summary

Deep infiltrative endometriosis is the most challenging type of endometriosis disease.

Surgical management is the one that most surgeons prefer for dealing with, while it requires experience and usually causes complications related to the requirement of difficult operative techniques. Thus, it would be essential if a noninvasive option would be as effective as surgery.

In the comparative retrospective annalistic study conducted by Rezende et al, the authors questioned whether hormonal medications alone or if continued after surgery, are as effective as the surgery itself.

Hundred and twenty-two women have been selected using a retrospective convenience sampling method from patient archives. According to the hospital’s protocol, all women who had surgery had at least 6 months of hormone-based treatment, and the pain management has been failed. After surgery, some of the patients continued hormonal treatment while the rest have not; and those who had hormonal therapies have been counted in as the third group.

The control group has been defined as the women who are on hormonal therapy for 6 months and have not had surgery. This group has been used to compare with both the surgery group and women on hormonal pills after the surgery. The pain was scaled by using the VAS scale with Deep Dyspareunia Scale and baseline numbers have been evaluated as at the time of surgery for the surgery group; and, at the beginning of hormonal treatment for the control group.

Both approaches have been found to be effective to reduce pain. But for deep pain, dyspareunia and dyschezia, surgery was significantly more effective than medication alone.

While the retrospective design of the study gave it some limitations, the authors concluded that in cases of deep dyspareunia, surgery should be the option that should not be delayed.

Research Source: https://pubmed.ncbi.nlm.nih.gov/35060442/