Clinical and endocrine effects of pharmacological therapy in endometriosis: a systematic review and meta-analysis

Background: Endometriosis, PCOS, adenomyosis, and dysmenorrhea are major illnesses. Hormonal as well as non-hormonal treatments were evaluated for COCs, progestins, GnRH analogues, LNG-IUS, relugolix, and adjunctive therapies. These treatments resulted in the categorization of the benefits in varying degrees. Methods: 149 clinical trials have been included. Evaluating the methodological quality was done through the Jadad scale, while the GRADE criteria were used to assess the reliability of the evidence. When these data were available, effect sizes, standardized mean differences (SMD), 95% confidence intervals (CI), and p-values were extracted. Results: It was observed that COCs and progestins considerably lowered pelvic pain and menstrual irregularities (SMD -0.35 to -0.58, 95% CI -0.90 to -0.08, p<0.05), and among various trials, dienogest was reported to be the most effective in alleviating dysmenorrhea (SMD -0.58, 95% CI -0.90 to -0.26, p<0.001). The use of relugolix in combination resulted in considerable pain reduction related to endometriosis (SMD -0.72, 95% CI -0.94 to -0.50, p<0.001), and the study was rated as excellent quality with GRADE and Jadad scores of 5. GnRH analogs led to pain reduction all the time (SMD -0.65, 95% CI -0.88 to -0.42, p<0.001), while the application of LNG-IUS was linked to less menorrhagia and lower recurrence after surgery (RR 0.51, 95% CI 0.33-0.79, p=0.002). Besides the main treatments, usage of the like of antioxidants, NAC, melatonin, and digital therapeutics, too, gave extra pain relief and quality-of-life benefits (SMD -0.40 to -0.62, p<0.05). the studies frequently proved to have a very rigorous quality of methodology (Jadad 3-5) and moderate-to-high grade certainty of evidence (GRADE). Conclusions: Endometriosis disorder have been treated well with hormonal therapies. Different endocrine therapies based on the patient's specific characteristics and the degree of tolerability should be used to achieve the maximum effect of clinical outcomes.