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Noncyclic Chronic Pelvic Pain Therapies for Women

Slide: 15 of 24

Comparative Effectiveness of Non-surgical Interventions for Noncyclic CPP: Pain Outcomes (1 of 2)

Of the various non-surgical interventions for noncyclic CPP, hormonal treatments were the most common modality assessed. Nine out of 17 studies investigating non-surgical interventions for noncyclic CPP focused on hormonal therapies. Studies of hormonal therapies were mainly conducted in patients with pelvic pain with or without an underlying diagnosis of endometriosis.

There was low-level evidence that the selective estrogen receptor modulator raloxifene resulted in a quicker return to pain than placebo. In a good-quality RCT of patients with pelvic pain associated with biopsy-proven endometriosis, those who received raloxifene experienced a return of pain significantly sooner after laparoscopy (OR, 2.81; 95% CI,1.41–6.19). The effect was so pronounced that the trial was stopped early.

There was low-level evidence that treatment with depot leuprolide resulted in a greater reduction in pain when compared with placebo. In one fair-quality RCT, participants with clinically suspected endometriosis randomized to depot leuprolide had significantly greater improvement in pelvic pain scores at the end of 12 weeks of treatment when compared with participants randomized to placebo (p < 0.001).