Non‐steroidal anti‐inflammatory drugs for pain in women with endometriosis
Abstract
Background
Endometriosis is a common gynaecological condition that affects women and can lead to painful symptoms and infertility. It affects women's quality of life greatly, impacting on their careers, everyday activities, sexual and non‐sexual relationships, and fertility. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are the most commonly used first‐line treatment for endometriosis.
Objectives
To assess the effects of NSAIDs for the management of pain in women with endometriosis compared to placebo, other NSAIDs, other pain management drugs, or no treatment.
Search methods
We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Trials Register (May 2005) published in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to May 2005), EMBASE (1980 to May 2005) and the reference lists from relevant publications. Experts in the field were also contacted for information about possible studies.
Selection criteria
We included all randomized controlled trials (RCTs) describing the use of NSAIDs in the treatment of endometriosis in women of all ages.
Data collection and analysis
Two review authors (CA and SH) independently read and extracted data from each of the included studies. Crossover trials were analysed using the inverse variance method in RevMan to calculate the odds ratio for binary outcomes.
Main results
Two trials were identified but only one trial, with 24 women, was included in the analysis. Comparing NSAIDs (naproxen) to placebo, there was no evidence of a positive effect on pain relief (odds ratio (OR) 3.27, 95% CI 0.61 to 17.69) in women with endometriosis. There was also inconclusive evidence to indicate whether women taking NSAIDs (naproxen) were less likely to require additional analgesia (OR 0.12, 95% CI 0.01 to 1.29) or experience side effects (OR 0.46, 95% CI 0.09 to 2.47) when compared to placebo.
Authors' conclusions
There is inconclusive evidence to show whether NSAIDs (naproxen) are effective in managing pain caused by endometriosis. There is no evidence to show whether any individual NSAID is more effective than another. As shown in other Cochrane reviews, women using NSAIDs need to be aware of the possibility that these drugs may cause unintended effects.
PICOs
Plain language summary
Non‐steroidal anti‐inflammatory drugs for treatment of pain in women with endometriosis
Endometriosis is a common gynaecological condition that affects women. It can lead to painful symptoms including painful periods, pain during or after sexual intercourse, pelvic and lower abdominal pain, and infertility. It can affect women's quality of life greatly by impacting on their careers, everyday activities, sexual and non‐sexual relationships, and fertility. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are the most commonly used first‐line treatment for endometriosis because they have few side‐effects and many are available over the counter. This review found limited evidence to show whether NSAIDs (naproxen) are effective for the treatment of pain caused by endometriosis. There is no evidence to show whether any individual NSAID is more effective than another. As shown in other Cochrane reviews, women using NSAIDs need to be aware of the risk that NSAIDs may cause adverse effects such as nausea, vomiting, headache, and drowsiness. This review is limited as it only included one study which involved 20 women.
