Is Administration of Depot Medroxyprogesterone Acetate Injections Every Three Months Effective in Decreasing Pain Associated with Endometriosis in Premenopausal Women

OBJECTIVE: The objective of this systematic EBM review is to determine whether or not the administration of depot medroxyprogesterone acetate injections every three months are effective in decreasing pain associated with endometriosis in premenopausal women. STUDY DESIGN: A review of two randomized controlled trials and one randomized comparative trial comparing pain improvement from depot medroxyprogesterone acetate (DMPA) injections at different time intervals and/or in comparison to other hormonal birth control methods in premenopausal patients suffering from endometriosis. DATA SOURCES: Randomized controlled trials and a randomized comparative trial were found using PubMed and Ovid MEDLINE databases. OUTCOME MEASURED: Outcomes were measured for reduction of pain by a verbal rating scale and/or a 10-cm or a 100-mm visual analog scale. RESULTS: Wong et al found that the pain score was significantly reduced all through the study period as long as the therapy of 150mg DMPA intramuscular injection every three months was continued (in all patients but one). Both Cheewadhanaraks et al and Walch et al showed a decreased in pain scores with DMPA in comparison to the control, but neither article calculated statistics comparing these scores to the baseline, therefore results are inconclusive whether or not pain associated with endometriosis is decreased with administration of DMPA injections every three months in premenopausal women. CONCLUSION: Based on the articles reviewed, one of the articles showed evidence that 150mg injections of DMPA administered every three months is an effective means of decreasing endometriosis-associated pain in premenopausal women. The other two articles had inconclusive results, therefore further research is warranted.