Hormonal Therapy for Pelvic Pain

There are multiple pathophysiological pathways involved in chronic pelvic pain (CPP). One such mechanism involves the role of sex steroid hormones (androgens, estrogens, and progestins) in the structure and function of genital tissues. Despite the high prevalence of CPP, there are very few comprehensive guidelines examining hormonal therapy for management of these patients. Currently, there is no consensus regarding measurement of hormones during evaluation and treatment of CPP. It is, however, important to understand how types of hormonal therapy can be used in management of pelvic pain. This chapter provides an overview of various causes of pelvic pain in which incorporating hormonal therapy can be effective. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of the North American Menopause Society. Menopause. 2007;14:355–69. Lynch C. Vaginal estrogen therapy for the treatment of atrophic vaginitis. J Womens Health. 2009;18(10):1595–606. Ibe C, Simon JA. Continuing medical education: vulvovaginal atrophy: current and future therapies (CME). J Sex Med. 2010;7(3):1042–50. Stika CS. Atrophic vaginitis. Dermatol Ther. 2010;23(5):514–22. Bachmann G, et al. Efficacy of low-dose estradiol vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial. Obstet Gynecol. 2008;111(1):67–76. Michael KL. Vaginal estrogens for the treatment of dyspareunia. J Sex Med. 2011;8(3):666–74. Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2006;4:CD001500. Kingsberg S, Kellogg S, Krychman M. Treating dyspareunia caused by vaginal atrophy: a review of treatment options using vaginal estrogen therapy. Int J Womens Health. 2009;1:105–11. Santen RJ, et al. Treatment of urogenital atrophy with low-dose estradiol: preliminary results. Menopause. 2002;9(3):179–87. Casper F, Petri E, Vaginal Ring Study Group. Local treatment of urogenital atrophy with an estradiol-releasing vaginal ring: a comparative and a placebo-controlled multicenter study. Int Urogynecol J. 1999;10(3):171–6. Bachmann G. The estradiol vaginal ring—a study of existing clinical data. Maturitas. 1995;22:S21–9. Ayton RA, et al. A comparative study of safety and efficacy of continuous low dose oestradiol released from a vaginal ring compared with conjugated equine oestrogen vaginal cream in the treatment of postmenopausal urogenital atrophy. BJOG. 1996;103(4):351–8. Naessen T, Berglund L, Ulmsten U. Bone loss in elderly women prevented by ultralow doses of parenteral 17β-estradiol. Am J Obstet Gynecol. 1997;177(1):115–9. Naessen T, Rodriguez Macias KA, Lithell H. Serum lipid profile improved by ultra-low doses od 17-ß estradiol in elderly women. J Clin Endocrinol Metab. 2001;6:2757. Eriksen PS, Rasmussen H. Low-dose 17β-estradiol vaginal tablets in the treatment of atrophic vaginitis: a double-blind placebo controlled study. Eur J Obstet Gynecol Reprod Biol. 1992;44(2):137–44. Rioux JE, et al. 17 [beta]-Estradiol vaginal tablet versus conjugated equine estrogen vaginal cream to relieve menopausal atrophic vaginitis. Menopause. 2000;7(3):156–61. Witherby S, et al. Topical testosterone for breast cancer patients with vaginal atrophy related to aromatase inhibitors: a phase I/II study. Oncologist. 2011;16(4):424–31. Society NAM. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888–902. Goldstein SR, et al. Postmenopausal evaluation and risk reduction with lasofoxifene (PEARL) trial: 5-year gynecological outcomes. Menopause. 2011;18(1):17–22. Panjari M, Davis SR. Vaginal DHEA to treat menopause related atrophy: a review of the evidence. Maturitas. 2011;70(1):22–5. Giudice LC. Endometriosis. N Eng J Med. 2010;362(25):2389–98. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98(3):511–9. Bruner-Tran KL, et al. Medical management of endometriosis: emerging evidence linking inflammation to disease pathophysiology. Minerva Ginecol. 2013;65(2):199. Strauss III, Jerome F, Barbieri RL. Yen & Jaffe’s reproductive endocrinology: physiology, pathophysiology, and clinical management. Amsterdam: Elsevier Health Sciences; 2013. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility. Fertil Steril. 2006;86:S156–60. Jacobson TZ, et al. Laparoscopic surgery for pelvic pain associated with en-dometriosis. Status and date: Edited (no change to conclusions), published in 11 (2009). Sutton CJG, et al. Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis. Fertil Steril. 1997;68(6):1070–4. Susan F, et al. Pre and post-operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev. 2004;3:CD003678. Angioni S, et al. New trends of progestins treatment of endometriosis. Gynecol Endocrinol. 2014;30(11):769–73. Soares SR, et al. Pharmacologic therapies in endometriosis: a systematic review. Fertil Steril. 2012;98(3):529–55. Seracchioli R, et al. Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis. Hum Reprod. 2009;24(11):2729–35. Harada T, et al. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril. 2008;90(5):1583–8. Ruhland B, et al. Innovations in conservative endometriosis treatment: an updated review. Minerva Ginecol. 2011;63(3):247–59. Guzick DS, et al. Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Fertil Steril. 2011;95(5):1568–73. Vercellini P, et al. Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. Fertil Steril. 2003;80(3):560–3. Schindler AE. Dienogest in long-term treatment of endometriosis. Int J Womens Health. 2011;3:175–84. Nakamura M, et al. Dienogest, a synthetic steroid, suppresses both embryonic and tumor-cell-induced angiogenesis. Eur J Pharmacol. 1999;386(1):33–40. Köhler G, et al. A dose-ranging study to determine the efficacy and safety of 1, 2, and 4 mg of dienogest daily for endometriosis. Int J Gynecol Obstet. 2010;108(1):21–5. Momoeda M, et al. et al. "A randomized, double-blind, multicenter, parallel, dose–response study of dienogest in patients with endometriosis."JAPANESE. Pharmacol Ther. 2007;35(7):769. Auge LM, et al. Dienogest is a safe and effective treatment for chronic pelvic pain associated to endometriosis. Fertil Steril. 2014;102(3), e289. Petraglia F, et al. Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Arch Gynecol Obstet. 2012;285(1):167–73. Strowitzki T, et al. Detailed analysis of a randomized, multicenter, comparative trial of dienogest versus leuprolide acetate in endometriosis. Int J Gynecol Obstet. 2012;117(3):228–33. Tekin YB, et al. Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Fertil Steril. 2011;95(2):492–6. Wong AY, Tang LC, Chin RK. Levonorgestrel-releasing intrauterine system (Mirena®) and depot medroxyprogesterone acetate (Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2010;50(3):273–9. Vercellini P, Cortesi I, Crosignani PG. Progestins for symptomatic endometriosis: a critical analysis of the evidence. Fertil Steril. 1997;68(3):393–401. Petta CA, et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum Reprod. 2005;20(7):1993–8. Basu A, Haran M, Nair A. Letter in response to Levonorgestrel-releasing intrauterine system (Mirena) and Depot medroxyprogesterone acetate (Depo-Provera) as long term maintenance therapy for patients with moderate and severe endometriosis: a randomised trial by Wong AYK, Tang LCH, Chin RKH, Aust NZJ Obstet Gynaecol 2010; 50 (3):273–279. Aust N Z J Obstet Gynaecol. 2011;51(1):97–8. Abou-Setta AM, Al-Inany HG, Farquhar CM. Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev. 2006;4, CD005072. Walch K, et al. Implanon® versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis—a pilot study. Contraception. 2009;79(1):29–34. Prentice A, et al. Gonadotropin-releasing hormone analogues for pain associated with endometriosis. Cochrane Libr. 2000;2, CD000346. Strowitzki T, et al. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod. 2010;25(3):633–41. Kennedy S, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698–704. Abushahin F, et al. Aromatase inhibition for refractory endometriosis-related chronic pelvic pain. Fertil Steril. 2011;96(4):939–42. Hefler LA, et al. Role of the vaginally administered aromatase inhibitor anastrozole in women with rectovaginal endometriosis: a pilot study. Fertil Steril. 2005;84(4):1033–6. Cottreau CM, et al. Endometriosis and its treatment with danazol or lupron in relation to ovarian cancer. Clin Cancer Res. 2003;9(14):5142–4. Ventolini G. Vulvar pain: anatomic and recent pathophysiologic considerations. Clin Anat. 2013;26(1):130–3. Wesselmann U, Bonham A, Foster D. Vulvodynia: current state of the biological science. Pain. 2014;155(9):1696–701. Eppsteiner E, Lori B, Stockdale CK. Vulvodynia. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1000–12. Ben-Aroya Z, Edwards L. Vulvodynia. Semin Cutan Med Surg. 2015;34(4):192–8. Zolnoun D, et al. A conceptual model for the pathophysiology of vulvar vestibulitis syndrome. Obstet Gynecol Surv. 2006;61(6):395–401. Greenstein A, et al. Vulvar vestibulitis syndrome and estrogen dose of oral contraceptive pills. J Sex Med. 2007;4(6):1679–83. Eva LJ, et al. Estrogen receptor expression in vulvar vestibulitis syndrome. Am J Obstet Gynecol. 2003;189(2):458–61. Bouchard C, et al. Use of oral contraceptive pills and vulvar vestibulitis: a case–control study. Am J Epidemiol. 2002;156(3):254–61. Burrows LJ, Goldstein AT. The treatment of vestibulodynia with topical estradiol and testosterone. Sex Med. 2013;1(1):30–3. Panzer C, Wise S, Fantini G, Kang D, Munarriz R, Guay A, Goldstein I. Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. J Sex Med. 2006;3:104–13. Author information Authors and Affiliations Editor information Editors and Affiliations Rights and permissions Copyright information © 2017 Springer International Publishing AG About this chapter Cite this chapter King, A., Bahlani, S. (2017). Hormonal Therapy for Pelvic Pain. In: Moldwin, R. (eds) Urological and Gynaecological Chronic Pelvic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-48464-8_13 Download citation DOI: https://doi.org/10.1007/978-3-319-48464-8_13 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-319-48462-4 Online ISBN: 978-3-319-48464-8 eBook Packages: MedicineMedicine (R0)

- GnRH Agonist - Chronic Pelvic Pain - creamConjugated Equine Estrogen - Endometriotic Lesion - Serum Estradiol Level These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.