Cochrane · systematic review · CD003678
Pre‐ and postsurgical medical therapy for endometriosis surgery
Chen, I, Veth, VB, Choudhry, AJ, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
18
current version
GRADE rated
13
No studies
5
Included studies
NR
No studies 5 · 27.8%Ungraded 0 · 0%Very low 9 · 50%Low 3 · 16.7%Moderate 1 · 5.6%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyPresurgical medical therapy compared with placebo or no medical therapy
Population: women having endometriosis surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (continuous) Pelvic pain ≤ 12 months Presurgical medical therapy vs placebo or no medical therapy | no estimate extracted | NR | No studies |
Pain recurrence (dichotomous) Pain recurrence ≤ 12 months Presurgical medical therapy vs placebo or no medical therapy | RR 1.1 [0.72, 1.66] | 1 study · 262 participants | Very low Downgraded: risk of bias, imprecision |
Disease recurrence at 3 months – total (AFS score) Presurgical medical therapy vs placebo or no medical therapy | no estimate extracted | 1 study · 80 participants | Very low Downgraded: risk of bias, imprecision |
Disease recurrence ≤ 12 months (dichotomous) Presurgical medical therapy vs placebo or no medical therapy | no estimate extracted | NR | No studies |
Disease recurrence ≤ 12 months (EEC stage) Presurgical medical therapy vs placebo or no medical therapy | RR 1.11 [0.86, 1.43] | 1 study · 262 participants | Very low Downgraded: risk of bias, imprecision |
Pregnancy rate (dichotomous) Presurgical medical therapy vs placebo or no medical therapy | RR 1.18 [0.97, 1.45] | 1 study · 262 participants | Very low Downgraded: risk of bias, imprecision |
Postsurgical medical therapy compared with placebo or no medical therapy
Population: women having endometriosis surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (continuous) Pelvic pain ≤ 12 months Postsurgical medical therapy vs placebo or no medical therapy | no estimate extracted | 3 studies · 340 participants | Very low Downgraded: risk of bias, inconsistency |
Pain recurrence (dichotomous) Pain recurrence ≤ 12 months Postsurgical medical therapy vs placebo or no medical therapy | RR 0.7 [0.52, 0.94] | 5 studies · 657 participants | Low Downgraded: risk of bias, imprecision |
Disease recurrence at 12 months – total (AFS score) Postsurgical medical therapy vs placebo or no medical therapy | no estimate extracted | 1 study · 53 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Disease recurrence ≤ 12 months (dichotomous) Postsurgical medical therapy vs placebo or no medical therapy | RR 0.3 [0.17, 0.54] | 4 studies · 433 participants | Low Downgraded: risk of bias |
Disease recurrence ≤ 12 months (EEC stage) Postsurgical medical therapy vs placebo or no medical therapy | RR 0.88 [0.67, 1.15] | 1 study · 285 participants | Very low Downgraded: risk of bias |
Pregnancy rate (dichotomous) Postsurgical medical therapy vs placebo or no medical therapy | RR 1.19 [1.02, 1.38] | 11 studies · 955 participants | Moderate Downgraded: risk of bias |
Presurgical medical therapy compared with postsurgical medical therapy
Population: women having endometriosis surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (continuous) Pelvic pain ≤ 12 months Presurgical medical therapy vs postsurgical medical therapy | no estimate extracted | NR | No studies |
Pain recurrence (dichotomous) Pain recurrence ≤ 12 months Presurgical medical therapy vs postsurgical medical therapy | RR 1.4 [0.95, 2.07] | 2 studies · 326 participants | Low Downgraded: risk of bias, imprecision |
Disease recurrence at 12 months –total (AFS score) Presurgical medical therapy vs postsurgical medical therapy | no estimate extracted | NR | No studies |
Disease recurrence ≤ 12 months (dichotomous) Presurgical medical therapy vs postsurgical medical therapy | no estimate extracted | NR | No studies |
Disease recurrence ≤ 12 months (EEC stage) Presurgical medical therapy vs postsurgical medical therapy | RR 1.26 [0.97, 1.65] | 1 study · 273 participants | Very low Downgraded: risk of bias, imprecision |
Pregnancy rate (dichotomous) Presurgical medical therapy vs postsurgical medical therapy | RR 1.08 [0.9, 1.3] | 1 study · 273 participants | Very low Downgraded: risk of bias, imprecision |
Post surgical medical therapies compared to No treatment or placebo for infertility associated with endometriosis
Population: patients with infertility associated with endometriosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pregnancy Post surgical medical therapies vs No treatment or placebo | RR 0.84 [0.59, 1.18] | 8 studies · 420 participants | Low Downgraded: risk of bias |
Pre and post operative medical therapies versus placebo for endometriosis
Population: patients with infertility associated with endometriosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pregnancy Rate Pre and post operative medical therapies vs placebo | RR 0 [0, 0] | 1 study · 25 participants | Low Downgraded: risk of bias |
Pre‐surgical medical therapy compared to no medical therapy for endometriosis surgery
Population: patients with endometriosis surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recurrence ‐ AFS Score ‐ Total AFS Pre‐surgical medical therapy vs no medical therapy | no estimate extracted | 1 study · 80 participants | Low Downgraded: risk of bias |
Post‐surgical medical therapy compared to placebo or no treatment for endometriosis
Population: patients with endometriosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (VAS) ‐ Dysmenorrhoea at 12 months Post‐surgical medical therapy vs placebo or no treatment | no estimate extracted | 1 study · 187 participants | Low Downgraded: risk of bias, imprecision |
Pain (dichotomous) ‐ Pain recurrence </= 12 months Post‐surgical medical therapy vs placebo or no treatment | RR 0.76 [0.52, 1.1] | 3 studies · 332 participants | Low Downgraded: risk of bias |
Pain (dichotomous) ‐ pain persistence/recurrence 5 years Post‐surgical medical therapy vs placebo or no treatment | RR 0.93 [0.53, 1.66] | 1 study · 54 participants | Very low Downgraded: risk of bias, imprecision |
Recurrence ‐ AFS Score ‐ Total AFS score (12 months) Post‐surgical medical therapy vs placebo or no treatment | no estimate extracted | 1 study · 43 participants | Low Downgraded: risk of bias, imprecision |
Pre‐surgical compared to Post‐surgical medical therapy for endometriosis surgery
Population: patients with endometriosis surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (Dichotomous) ‐ Dysmenorrhoea Pre‐surgical vs Post‐surgical medical therapy | no estimate extracted | 1 study · 53 participants | Low Downgraded: risk of bias |
Post‐surgical medical therapy compared to Pre and post‐surgical medical therapy with GnRHa for endometriosis surgery
Population: patients with endometriosis surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recurrence ‐ AFS Score ‐ Total AFS score Post‐surgical medical therapy vs Pre and post‐surgical medical therapy with GnRHa | no estimate extracted | 1 study · 25 participants | Very low Downgraded: risk of bias |