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Endometriosis

from Chief complaints and diagnoses

Published online by Cambridge University Press:  18 December 2009

By
Joshua H. Tamayo-Sarver  and
Rita K. Cydulka
Edited by
Stephen H. Thomas
Stephen H. Thomas
Affiliation:
Harvard Medical School
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Summary

NSAIDs are widely considered as the first-line therapy for the pain associated with endometriosis. Combined oral contraceptive pills (COCPs) are generally recommended as the second-line therapy for endometriosis pain. A 2007 Cochrane review concluded that COCPs are at least as effective as gonadotropin-releasing hormone (GnRH) agonists. Medroxyprogesterone acetate is comparable to the androgen danazol, with both agents reducing pain scores by 50-74% compared with placebo. An SC form of depot medroxyprogesterone appears to relieve endometriosis as effectively as the proven approach of the GnRH agonist leuprolide acetate. Cochrane review has shown that there is generally equivalent pain relief achieved with multiple endocrine therapies for endometriosis. The myriad menopausal, androgenic, and hepatic side effects from some of the endocrine agents (e.g. danazol) used to treat endometriosis should serve to underline the importance of ED physician communication and follow-up arrangements with longitudinal care providers.

Keywords

corticosteroidslocal anestheticsnon-septic bursitisNSAIDsprotease inhibitorstrochanteric bursitisperiarticular inflammation
Type
Chapter
Information
Emergency Department Analgesia
An Evidence-Based Guide
 , pp. 197 - 199
Publisher: Cambridge University Press
Print publication year: 2008

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