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Frontiers in Medicine 2022This systematic review aimed to assess the efficacy and safety of Drospirenone and Ethinylestradiol Tablets (II) in the treatment of dysmenorrhea.
AIM
This systematic review aimed to assess the efficacy and safety of Drospirenone and Ethinylestradiol Tablets (II) in the treatment of dysmenorrhea.
METHODS
Electronic databases, namely PubMed, Embase, Cochrane Controlled Register of Trials (CENTRAL), Scopus, Science, CBM, CNKI, Wanfang, and VIP, were searched before September 2022. Randomized controlled trials (RCTs), non-randomized controlled trials, cohort studies, case-control studies, and single-arm studies were included. Furthermore, the Cochrane Risk of Bias Tool for Systematic Reviews version 1 was used for the risk of bias assessment on RCTs. The Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool was used for risk of bias assessment on non-randomized studies. The risk ratio (RR) was calculated for dichotomous data. Mean difference (MD) or standardized MD (SMD) were used as the effect size for continuous data.
RESULTS
A total of 11 studies involving 2,251 participants with dysmenorrhea were included. When Drospirenone and Ethinylestradiol Tablets (II) conventional 24/4-day regimen was compared with placebo, the total efficiency rate (defined as pain symptom disappearing or being relieved) in Drospirenone and Ethinylestradiol Tablets (II) 24/4-day regimen group was higher than in placebo group (RR = 5.55, 95%CI: 2.48-12.39, < 0.0001). No clear differences were found on risk of overall adverse events or specific adverse events. When Drospirenone and Ethinylestradiol Tablets (II) was compared with active control drugs, no clear differences were found on the total efficiency rate or visual analog scale (VAS) scores for dysmenorrhea and other related pain. The risk of overall adverse events decreased in Drospirenone and Ethinylestradiol Tablets (II) conventional 24/4-day regimen (13/53 vs. 66/148, RR = 0.55, 95%CI: 0.33-0.91) when compared with active control drugs group. When Drospirenone and Ethinylestradiol Tablets (II) flexible extended regimen was compared with conventional 24/4-day regimen, the number of days of dysmenorrhea (MD=-3.98, 95%CI: -5.69 to -2.27), and dysmenorrhea associated with unscheduled bleedings (MD = -1.6, 95%CI: -2.8 to -0.5), were fewer in flexible extended regimen. In addition, there were no differences found on risk of adverse events (including mood changes, spotting, headache, breast pain, nausea, and vomiting) between compared groups ( > 0.05).
CONCLUSION
Drospirenone and Ethinylestradiol Tablets (II) could improve symptoms of dysmenorrhea and decrease other related pain symptoms. More high-quality evidence is needed to confirm the advantages.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021271605], identifier [CRD42021271605].
PubMed: 36590937
DOI: 10.3389/fmed.2022.938606 -
Reproductive Biology and Endocrinology... Dec 2022There is a growing body of human, animal and in vitro studies on vitamin D (vit D) substitution in endometriosis. The aim of this systematic review is to critically... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is a growing body of human, animal and in vitro studies on vitamin D (vit D) substitution in endometriosis. The aim of this systematic review is to critically appraise and qualitatively synthesize the results of the available studies that examine the supplementation of vit D for endometriosis treatment.
METHODS
A systematic search of the literature was conducted in four electronic databases (Medline, Cochrane, Scopus, Embase) and grey literature for original research articles on humans, animals and in vitro models published in any language.
RESULTS
Four human studies, four animal studies and four in vitro studies were included. Quantitative synthesis of human studies showed no significant effect of vit D intake for dysmenorrhea (2 studies, 44 vit D vs 44 placebo, mean -0.71, 95% CI -1.94, 0.51) and non-cyclic pelvic pain (2 studies, 42 vit D vs 38 placebo, mean 0.34, 95% CI -0.02, 0.71). Regarding reproductive outcomes in women with endometriosis after in vitro fertilization, the only available study showed no differences between women taking vit D and women taking placebo. Three of the four included animal studies showed regression of endometriotic implants when treated with vit D. The in vitro studies demonstrated that vit D decreases invasion and proliferation of endometriotic lesions without affecting apoptosis.
CONCLUSIONS
Although in vitro and animal studies suggest regression of the endometriotic implants and decrease of invasion and proliferation after vit D supplementation, this was not reflected in the results of the meta-analysis, which showed no benefit of vit D supplementation in patients with endometriosis and dysmenorrhea or non-cyclic pelvic pain as well as on the outcome of IVF treatment. However, given the heterogeneity and the diversity of the available studies, more research is required to shed light on the role of vit D supplementation in women with endometriosis.
Topics: Animals; Humans; Female; Endometriosis; Dysmenorrhea; Vitamin D; Vitamins; Pelvic Pain; Dietary Supplements
PubMed: 36578019
DOI: 10.1186/s12958-022-01051-9 -
Clinical Nutrition ESPEN Dec 2022Primary dysmenorrhea (PD) refers to the presence of painful menstrual cramps due to increased synthesis of prostaglandins. Vitamin E inhibits the release of arachidonic... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
Primary dysmenorrhea (PD) refers to the presence of painful menstrual cramps due to increased synthesis of prostaglandins. Vitamin E inhibits the release of arachidonic acid and its conversion to prostaglandins through its antioxidant properties. This study sought to examine the effects of oral vitamin E supplementation on PD intensity (primary outcome) and its side effects (secondary outcomes).
METHODS
In this systematic review and meta-analysis, databases in English and Persian, including PubMed, Cochrane Library, Google Scholar, Scopus, Web of Science, SID, and Magiran, were systematically searched until August 30, 2021. The study included all randomized, controlled clinical trials comparing oral vitamin E to placebo in healthy women with PD and measuring PD severity as a primary or secondary outcome. The quality of the included articles was assessed using the Cochrane Handbook, and the meta-analysis was performed using RevMan software. Given the continuous nature of the data and the utilization of different tools in the extracted articles, the meta-analysis results were reported using standardized mean difference (SDM) and 95% confidence interval (95% CI). A subgroup analysis was performed in low-dose (100 units), moderate-dose (200 units), and high-dose (400 units) categories. The quality of evidence was examined according to the GRADE approach.
RESULTS
Eight articles with a sample size of 1002 people were entered into this systematic review. The results of meta-analysis revealed that vitamin E consumption significantly reduced PD mean intensity in the first month (n = 7 records; SDM = -1.16; 95%CI: -2.16 to -0.17; I = 31.9%; P = 0.02) and the second month (n = 8 records; SDM = -1.83; 95%CI: -2.90 to -0.77; I = 76.3.9%; P < 0.0001) compared with placebo. Serious side effects were not reported in vitamin E recipients.
CONCLUSION
Vitamin E could be an adjunctive treatment for women with PD. However, higher-quality clinical trials with larger sample sizes are recommended for a more definite conclusion.
PROSPERO ID
CRD42021276609.
Topics: Female; Humans; Dysmenorrhea; Vitamin E; Prostaglandins; Randomized Controlled Trials as Topic
PubMed: 36513486
DOI: 10.1016/j.clnesp.2022.10.001 -
Journal of Robotic Surgery Jun 2023We aim to assess the available evidence concerning the robot-assisted repair of cesarean scar defect. A systematic PubMed and Scopus search was conducted. All databases... (Review)
Review
We aim to assess the available evidence concerning the robot-assisted repair of cesarean scar defect. A systematic PubMed and Scopus search was conducted. All databases were assessed up to May 23, 2022. Studies reporting data on robot-assisted repair of cesarean scar defect were included in this review. Data of 34 patients are presented. The mean age of the patients was 34.8 years old. The mean number of times a woman has been pregnant (gravidity) was 3.1, while the mean number of parity among the included women was 1.9. The mean number of previous cesarean sections among the included women is 1.8. The commonest symptoms at presentation of cesarean scar defect were vaginal bleeding, dysmenorrhea, abdominal pain, secondary infertility amenorrhea and ectopic cesarean scar pregnancy. The gestational age at time of surgery ranged between 6 and 14 weeks. The mean operative time was 165.2 min, while the reported blood loss during the operation ranged between 0 and 400 ml. Bladder perforation was the only intraoperative complication reported (1 out of 34, 2.9%). No conversion to open was reported. The mean interval between the last cesarean section and the development of cesarean scar defect was 22.8 months. Subsequent pregnancy after robotic assisted repair was reported in 16 out of 34 patients (47.1%). Robot-assisted treatment for cesarean scar defect has acceptable effectiveness and risks. Based on available data, uterus-sparing therapy should be considered in patients with cesarean scar pregnancies or symptomatic cesarean scar defect who wish to preserve their fertility. Finally, the role of a combined robotic and hysteroscopic correction of cesarean scar defect for reducing the blood loss and reducing the following obstetrical complications warrants future research.
Topics: Pregnancy; Humans; Female; Adult; Infant; Cicatrix; Cesarean Section; Robotics; Robotic Surgical Procedures; Laparoscopy
PubMed: 36436106
DOI: 10.1007/s11701-022-01502-w -
Archives of Gynecology and Obstetrics Jan 2023Endometriosis is a common chronic gynecological disease defined as the presence of endometrial glands and stroma tissue outside the uterus. Gestrinone is an effective... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Endometriosis is a common chronic gynecological disease defined as the presence of endometrial glands and stroma tissue outside the uterus. Gestrinone is an effective antiestrogen that induces endometrial atrophy and/or amenorrhea. The purpose of this systematic review is to provide an evaluation of safety and effectiveness of gestrinone for the treatment of endometriosis.
METHODS
We performed a search in six electronic databases: PubMed, MEDLINE (ovid), Embase, Cochrane CENTRAL (clinical trials), Web of Science and Scopus. Our selected primary outcomes were the changes in dysmenorrhea, pain relief including pelvic pain and dyspareunia. The secondary outcomes embrace hormones parameters, pregnancy rate and adverse events.
RESULTS
Of 3269 references screened, 16 studies were included involving 1286 women. All studies compared gestrinone with other drugs treatments (placebo, Danazol, Mifepristone tablets, Leuprolide acetate, Quyu Jiedu Recipe) during 6 months. When compared with other drugs treatments, gestrinone relieved dysmenorrhea, pelvic pain, and morphologic response in the ovary. There was an increase on the pregnancy rate. Regarding the side effects observed, gestrinone showed the same adverse events and increased the risk of acne and seborrhea when compared to other treatments. Even if there was any difference in efficacy between gestrinone, danazol, leuprolide acetate, or Quyu Jiedu Recipe Chinese Medicine, it remains unclear due to insufficient data.
CONCLUSION
Based limited evidence available suggests that gestrinone appeared to be safe and may have some efficacy advantages over danazol, as well as other therapeutic interventions for treating endometriosis. However, this conclusion should be interpreted with caution, due the quality of the evidence provided is generally very low or unclear.
TRIAL REGISTRATION
CRD42021284148.
Topics: Pregnancy; Female; Humans; Endometriosis; Gestrinone; Danazol; Leuprolide; Dysmenorrhea; Pelvic Pain
PubMed: 36434439
DOI: 10.1007/s00404-022-06846-0 -
Complementary Medicine Research 2023The study aimed to identify the effects of transcutaneous electrical nerve stimulation (TENS) in women with chronic pelvic pain (CPP) by conducting a systematic review... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The study aimed to identify the effects of transcutaneous electrical nerve stimulation (TENS) in women with chronic pelvic pain (CPP) by conducting a systematic review and meta-analysis of randomized controlled trials.
METHODS
We used five international databases from 2000 to 2020 and selected the clinical trials that reported the effects of TENS on CPP. We excluded the case reports, acute pelvic pain reports, men-related, animal-related, and intravaginal and intrarectal electrical stimulation articles. The level of pain (based on the visual analog scale) was considered for pooling data through the meta-analysis.
RESULTS
Ten studies met the inclusion criteria, and three articles were included in the meta-analysis. The results showed that TENS application mildly reduced pain in women with primary dysmenorrhea (mean difference = -1.29; 95% CI: -2.57 to -0.01; Z = 1.98, p = 0.05). Also, to reduce pain in patients with CPP, the TENS must be applied at least for 20 min, with a pulse duration of 50-400 μs, at a frequency of 2-120 Hz. The meta-analysis was followed by assessing the risk of bias, including publication bias. Based on the Cochrane risk of bias evaluation, the majority of the included trials were assessed with moderate methodological quality.
CONCLUSION
TENS application can mildly improve the level of pain in patients with CPP caused by primary dysmenorrhea. Although no distinct agreement was observed among the effective parameters, the high-frequency mode with maximum tolerated intensity was more effective compared to the low-frequency mode.
Topics: Humans; Female; Transcutaneous Electric Nerve Stimulation; Dysmenorrhea; Pain Measurement; Heart Rate
PubMed: 36412569
DOI: 10.1159/000528133 -
Frontiers in Global Women's Health 2022To compare efficacy and safety of the levonorgestrel-releasing intrauterine system (LNG-IUS) with systemic medication or blank control in the treatment of dysmenorrhea. (Review)
Review
Levonorgestrel-releasing intrauterine system vs. systemic medication or blank control for women with dysmenorrhea: Systematic review and meta-analysis of randomized controlled trials.
AIMS
To compare efficacy and safety of the levonorgestrel-releasing intrauterine system (LNG-IUS) with systemic medication or blank control in the treatment of dysmenorrhea.
METHODS
PubMed, EMBASE, the China National Knowledge Infrastructure (CNKI) and Wanfang Data were searched to collect randomized controlled trials (RCTs) comparing LNG-IUS with systemic medication or blank control among women diagnosed with primary dysmenorrhea or secondary dysmenorrhea (adenomyosis or endometriosis) from inception to 2020.04. Der Simonian-Laird random-effect model was used to pool data.
RESULTS
Seventy-one RCTs (6551 patients) were included. Overall bias risk was medium. Sixty-two articles enrolled patients with adenomyosis; LNG-IUS significantly reduced the visual analogue scale (VAS) score compared with the systemic medication group among adenomyosis women at 3 months (standardized mean difference (SMD) = -0.81, 95% confidence interval (CI) -1.22 to -0.40); 6 months (SMD = -1.25, 95%CI: -1.58 to -0.92); 9 months (SMD = -1.23, 95%CI: -1.63 to -0.83); 12 months (SMD = -1.66, 95%CI: -2.14 to -1.18). No difference was found in the incidence of irregular vaginal bleeding (16 RCTs; RR = 0.91, 95%CI: 0.62-1.33, = 0.63, = 4%) and other adverse outcomes. Sensitivity analysis regarding randomization methods was robust. Nine RCTs enrolled endometriosis women. Pooling results showed no significant difference between LNG-IUS and systemic medication treatment in terms of VAS at 6 months (SMD = -0.27, 95% CI: -0.97-0.43). Moreover, LNG-IUS was associated with higher risk of irregular vaginal bleeding (26.8% vs. 0).
CONCLUSIONS
LNG-IUS was associated with a reduced severity of dysmenorrhea compared with systemic medication; it was also beneficial for better control of menstrual blood loss and fewer adverse outcomes. Owing to small sample sizes, further well-designed RCTs are warranted to confirm these findings and long-term effects of LNG-IUS in the treatment of dysmenorrhea.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.
PubMed: 36405811
DOI: 10.3389/fgwh.2022.1013921 -
International Journal of Molecular... Oct 2022Endometriosis is defined as ectopic endometrial tissues dispersed outside the endometrium. This can cause disruption in hormonal and immunological processes, which may... (Meta-Analysis)
Meta-Analysis Review
Endometriosis is defined as ectopic endometrial tissues dispersed outside the endometrium. This can cause disruption in hormonal and immunological processes, which may increase susceptibility to SARS-CoV-2 infection. Worsening of endometriosis symptoms may occur as a result of this infection. The aim of our review was to estimate the pooled prevalence of SARS-CoV-2 infection and the health impacts of the COVID-19 pandemic in endometriosis patients. We conducted a systematic review and meta-analysis. MEDLINE, Science Direct, Scopus, and Google Scholar databases were searched, using the keywords: (endometriosis) AND (COVID-19 OR SARS-CoV-2). Forest plots and pooled estimates were created using the Open Meta Analyst software. After screening 474 articles, 19 studies met the eligibility criteria for the systematic review, and 15 studies were included in the meta-analyses. A total of 17,799 patients were analyzed. The pooled prevalence of SARS-CoV-2 infection in endometriosis patients was 7.5%. Pooled estimates for the health impacts were 47.2% for decreased access to medical care, 49.3% increase in dysmenorrhea, 75% increase in anxiety, 59.4% increase in depression, and 68.9% increase in fatigue. Endometriosis patients were undeniably impacted by the COVID-19 pandemic, which caused the worsening of symptoms such as dysmenorrhea, pelvic pain, anxiety, depression, and fatigue.
Topics: Female; Humans; COVID-19; Endometriosis; SARS-CoV-2; Pandemics; Dysmenorrhea; Prevalence; Fatigue
PubMed: 36361745
DOI: 10.3390/ijms232112951 -
Fertility and Sterility Dec 2022To review the use of oral gonadotropin-releasing hormone (GnRH) antagonists and synthesize their efficacy and safety parameters for the treatment of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To review the use of oral gonadotropin-releasing hormone (GnRH) antagonists and synthesize their efficacy and safety parameters for the treatment of endometriosis-associated pain.
DESIGN
Systematic review and network meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Premenopausal women with endometriosis who had experienced moderate or severe pain.
INTERVENTION(S)
The Web of Science, Embase, Scopus, and MEDLINE were searched until April 10, 2022. Only randomized controlled trials were included. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool 2. A Bayesian random-effects network meta-analysis was used to perform indirect comparisons. I was used to assess the global heterogeneity. Relative treatment estimates were performed. Treatment ranking was performed through the surface under the cumulative ranking curve. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework.
MAIN OUTCOME MEASURE(S)
Endometriosis-associated pain, dysmenorrhea, dyspareunia, and noncyclic pelvic pain reduction.
RESULT
(s): Five studies and 6 randomized controlled trials, including a total of 2,796 women and 10 different doses of oral GnRH antagonist treatments, were eligible for inclusion. All studies were considered to have a low risk of bias. Almost all efficacy- and safety-related outcomes showed a dose-response relationship. Regarding endometriosis-associated pain, the top 3 treatments were elagolix 400 mg, linzagolix 75 mg, and linzagolix 200 mg, with mean differences of -1.26 (95% credible interval [CrI], -1.70 to -0.79), -0.98 (95% CrI, -1.84 to -0.15), and -0.98 (95% CrI, -1.90 to -0.064), respectively. The top 3 treatments to decrease dysmenorrhea were relugolix 40 mg, elagolix 400 mg, and relugolix 20 mg, with mean differences of -1.60 (95% CrI, -2.07 to -1.14), -1.25 (95% CrI, -1.56 to -0.95), and -1.10 (95% CrI, -1.59 to -0.62), respectively. However, only high-dose treatments were significantly associated with most quality of life- and adverse effect-related outcomes. Relugolix 40 and 20 mg and elagolix 400 mg, with odds ratios of 6.88 (95% CrI, 2.18-24.58), 1.60 (95% CrI, 0.62-4.13), and 1.85 (95% CrI, 1.05-3.30), had a significantly increased incidence of adverse events.
CONCLUSION
(s): Oral GnRH antagonists are effective for endometriosis-associated pain and dysmenorrhea and the patient global impression. The incidence of ovarian hypoestrogenic effects in a short-term duration was significant in a dose-effect response, particularly the highest dose.
CLINICAL TRIAL REGISTRATION NUMBER
International Prospective Register of Systematic Reviews registration number CRD42022332904.
Topics: Female; Humans; Bayes Theorem; Dysmenorrhea; Endometriosis; Gonadotropin-Releasing Hormone; Hormone Antagonists; Network Meta-Analysis; Pelvic Pain; Quality of Life
PubMed: 36283862
DOI: 10.1016/j.fertnstert.2022.08.856 -
Computational Intelligence and... 2022To compare the efficacy of uterine artery embolization (UAE) with traditional methods for treating endometriosis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the efficacy of uterine artery embolization (UAE) with traditional methods for treating endometriosis.
METHODS
The randomized controlled trials of uterine artery embolization and other medical treatments for endometriosis in PubMed, Embase, Web of Science, Cochrane Library, China Journal Full-Text Database, Wanfang Database, VIP Database, and China Biomedical Literature Database were retrieved by computer. The search time was up to June 2022. The quality of articles was evaluated by Cochrane ROB 2.0, and meta-analysis was performed by Stata15.1 software.
RESULTS
7 studies were finally included. Meta-analysis showed that the serum CA125 level after uterine artery embolization was significantly lower than that in the control group (SMD = -0.85, 95%CI (-1.12, -0.59)], and the postoperative visual analogue scale (VAS) of dysmenorrhea was significantly lower than that in the control group (SMD = -1.86, 95%CI (-2.21, -1.50)) There was no significant difference in the effective rate, FSH level, E2 level, and LH level between the two groups.
CONCLUSION
UAE can effectively reduce the VAS score of dysmenorrhea and serum CA125 level for treating endometriosis. However, due to the limitation of the quality of included articles, more large sample size and high quality RCTs are needed to provide stronger evidence-based medicine evidence for clinical practice.
Topics: China; Dysmenorrhea; Endometriosis; Female; Follicle Stimulating Hormone; Humans; Uterine Artery Embolization
PubMed: 36248948
DOI: 10.1155/2022/8966063