The effect of surgery or medication on pain and quality of life in women with endometrioma. A systematic review and meta-analysis

Background- For patients with endometrioma it is unclear what treatment: surgery and/or medication, is more effective in reducing pain and improving quality of life (QoL). Objectives- To provide an overview of existing evidence on effects of surgery and/or medication on pain and QoL. Search Strategy- CENTRAL, MEDLINE and Embase were searched. Selection criteria - Women treated for endometrioma. Retrospective or prospective studies reporting about QoL and/or the following types of pain: dysmenorrhea, dyspareunia, chronic pelvic pain, and pain that was not well defined in the included article (referred to as pain). Data collection and Analysis - We performed a meta-analysis on mean visual analogue scale (VAS)-scores and proportions of patients experiencing different types of pain over time. QoL was described narratively. Main results- The systematic review included 76 studies (N=7148 patients). The meta-analysis included 52 studies (N=4556 patients). No studies compared medication with surgery. Meta-analysis showed that surgery and/or medication often reduced VAS-scores and proportions of all types of pain over time. Surgery+medication seemed more effective in reducing VAS-scores of pain compared to surgery (estimated mean difference=0.17, p<.0001). Median follow-up: 12 months (range: 3-155). QoL improved after medication and QoL was unchanged or worsened after surgery+medication. Conclusion and relevance- Both surgery and medication reduce endometriosis-related pain in patients with endometrioma. However, there is lack of uniform, good quality data comparing surgery with medication to draw firm conclusions. For better-informed treatment decisions, further studies including a standardized core-outcome set at fixed follow-up times, are necessary.