The DOI matches its Crossref record; 110 of the 112 references it cites were found in a registry or an index; none of the 72 sources its claims cite is checked for support yet.
“Waiting for Godot”: a commonsense approach to the medical treatment of endometriosis
Open accessAbstract
Conservative surgical treatment for symptomatic endometriosis is frequently associated with only partial relief of pelvic pain or its recurrence. Therefore, medical therapy constitutes an important alternative or complement to surgery. However, no available compound is cytoreductive, and suppression instead of elimination of implants is the only realistic objective of pharmacological intervention. Because this implies prolonged periods of treatments, only medications with a favourable safety/tolerability/efficacy/cost profile should be chosen. In the past few years, innumerable new drugs for endometriosis, which would interfere with several hypothesized pathogenic mechanisms, have been studied and their use foreseen. However, robust evidence of in vivo safety and efficacy is lacking and, at the moment, the principal modality to interfere with endometriosis metabolism is still hormonal manipulation. Regrettably, in spite of consistent demonstration of a major effect on pain even in patients with deeply infiltrating lesions, progestins are underestimated and dismissed in favour of more scientifically fashionable and up-to-the-minute alternatives. Moreover, oral contraceptives (OCs) dramatically reduce the rate of post-operative endometrioma recurrence and should now be considered an essential part of long-term therapeutic strategies in order to limit further damage to future fertility. Finally, women who have used OC for prolonged periods will be protected from an increased risk of endometriosis-associated ovarian cancer. To avoid the several subtle modalities for distorting facts and orientating opinions in favour of specific compounds, progestins and monophasic OC used continuously are here proposed as the reference comparator in all future randomized controlled trials on medical treatment for endometriosis.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This review argues that medical treatment for endometriosis should aim at long-term suppression rather than cure, and that progestins and continuous monophasic oral contraceptives (OCs) are effective, safe, inexpensive options that are underused. It proposes these as reference comparators in future randomized controlled trials and highlights postoperative OC use for preventing endometrioma and symptom recurrence.
Key findings
- No available drug is cytoreductive; suppression is the only realistic objective, so prolonged therapy is needed. In nine controlled trials identified from 1990–2010, progestins and OCs relieved pain and were generally not inferior to danazol, GnRH agonists, and aromatase inhibitors.
- Postoperative OC use dramatically reduced endometrioma recurrence in three controlled studies, with odds ratios from 0.04 (Takamura et al., 2009) to 0.32 (Seracchioli et al., 2010a). Two RCTs showed reduced dysmenorrhoea recurrence with postoperative progestin/OC versus expectant management (OR 0.14 and 0.32).
- Recurrence after conservative surgery is common: 10% at 1 year, 25% at 3 years, and 45% at 5 years (Evers et al., 1991); >20% at 2 years and 40–50% at 5 years (Guo, 2009); endometrioma recurrence reportedly 30–50% after 2–5 years.
- Costs are substantial: global endometriosis cost was $18.8–$22 billion per year based on 2002 US data; annual therapy costs ranged from €18 for low-dose norethisterone acetate to about €2100 for aromatase inhibitors or GnRH agonists, and about €4200 if combined.
Methods
- Narrative review/opinion article; no primary data. A MEDLINE search from January 1990 to July 2010 in English (MeSH terms: endometriosis, progestins, OCs, medical therapy) identified nine controlled trials comparing a progestin or OC with an alternative hormonal compound.
- A second MEDLINE search from January 2000 to July 2010 (MeSH terms: endometriosis, endometrioma, recurrence, OC, laparoscopy) identified three controlled studies on long-term postoperative OC use and endometrioma recurrence.
- The paper also cites RCTs on postoperative progestin/OC use for symptom recurrence; study quality was not assessed, and no meta-analysis was performed.
Limitations
- Stated: study quality was not assessed in the MEDLINE search; information on the cost of endometriosis to patients and society is limited.
- Evident: this is a narrative/opinion review with explicit advocacy for progestins and OCs, without systematic quality appraisal, risk-of-bias assessment, or meta-analysis; conclusions may be influenced by selected citation and interpretation of the literature.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
49 Not checked yet · 33 Own interpretation · 6 No basis given · 1 Own method
In the paper
“women who have used OC for prolonged periods will be protected from an increased risk of endometriosis-associated ovarian cancer”
- Also stated in: § Life is now! · hedged
“women who have used OC for prolonged periods might be reassured that they will be protected from an increase in risk of endometriosis-associated ovarian cancer (Missmer et al., 2004)”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Abstract
What the sources say
- Not checked yetcites Missmer et al., 2004 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Life is now! · hedged
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“in spite of consistent demonstration of a major effect on pain even in patients with deeply infiltrating lesions, progestins are underestimated and dismissed in favour of more scientifically fashionable and up-to-the-minute alternatives”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Abstract
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, robust evidence of in vivo safety and efficacy is lacking and, at the moment, the principal modality to interfere with endometriosis metabolism is still hormonal manipulation.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“oral contraceptives (OCs) dramatically reduce the rate of post-operative endometrioma recurrence”
- Also stated in: § Prevention of recurrence? Yes we can! · boosted
“A dramatic reduction in the risk of reappearance of endometriotic cysts in OC users was consistently observed independent of cyclic or continuous use, with odds ratios varying from 0.04 (Takamura et al., 2009) to 0.32 (Seracchioli et al., 2010a).”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Abstract
What the sources say
- Not checked yetcites Takamura et al., 2009
- Not checked yetcites Seracchioli et al., 2010a
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Prevention of recurrence? Yes we can! · boosted
None of the sources cited for this claim have been checked yet.
In the paper
“A decreased PR-B/PR-A ratio has been demonstrated not only in ectopic tissue (Attia et al., 2000), but also in eutopic endometrium of women with endometriosis (Igarashi et al., 2005), albeit not consistently (Bukulmez et al., 2008).”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Challenging conventional biologic wisdom
What the sources say
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“the induction of experimental disease in mice leads to a completely opposite hormonal receptor expression, as total endometrial PR and PR-B were shown to be increased, and PR-A decreased in animals with endometriosis”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Challenging conventional biologic wisdom
What the sources say
- Not checked yetcites Lee et al., 2009
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Numerous clinical studies and systematic reviews have consistently demonstrated that hormonal compounds with very dissimilar pharmacological profiles determine comparable pelvic pain reduction.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
What the sources say
- Not checked yetcites American College of Obstetricians and Gynecologysts, 2000
- Not checked yetcites Kennedy et al., 2005
- Not checked yetcites Royal College of Obstetricians and Gynaecologysts, 2006
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“and, most importantly, with potentially severe side effects”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“several of the compounds included in Table I are associated with uncertain or no efficacy, such as pentoxifylline (Lv et al., 2009) or anti-TNF-a (Lv et al., 2010)”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
What the sources say
- Not checked yetcites Lv et al., 2009
- Not checked yetcites Lv et al., 2010
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Almost all of the completed clinical trials for which no information on their outcome is available in the public domain were sponsored by pharmaceutical companies.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Introduction
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
- Probably not a substantial claim. 13
- The quote only partly states this claim. 1
- It may state two separate claims as one. 14
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, no available compound is cytoreductive, and suppression instead of elimination of implants is the only realistic objective of pharmacological intervention.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“generally well-tolerated”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Life is now!
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
In the paper
“After treatment discontinuation, symptoms recurred without significant between-group differences, demonstrating that also aromatase inhibitors are neither cytoreductive nor curative.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Pharmacological extravagance
What the sources say
- Not checked yetcites Ferrero et al., 2009b
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Disease control may result in an acceptable improvement of quality of life, only if also safety, tolerability and costs of medications are taken into adequate account.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The risk of major untoward effects may be acceptable in the above clinical context, but not in otherwise healthy women affected by a benign condition.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“there are also substantial economic implications if efficacy is overestimated and the medication over-utilized, given that usually new molecules are among the most costly drugs on the market”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Introduction
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: New molecules are usually among the most costly drugs on the market.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, again it is unclear if the increased expression of this cytochrome P-450 complex constitutes the very reason for survival and proliferation of regurgitated endometrial cells, or if it is the consequence of local inflammation”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Pharmacological extravagance
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Moreover, during the reproductive period, aromatase inhibitors stimulate ovarian function, as they reduce the hypothalamic-pituitary estrogen feedback, with consequent rise in GnRH secretion, elevations in FSH and LH, and augmented follicular development.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Pharmacological extravagance
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“for the present the therapeutic target is not endometriosis cytoreduction, but suppression, which implies the survival of ectopic implants independently of the drug type, dosage, and duration of use (Evers, 1987)”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
What the sources say
- Not checked yetcites Evers, 1987 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: A compound with selective properties only against the ectopic endometrial cell has not yet been synthesized.
In the paper
“According to Evers et al. (1991), 10% of patients redeveloped signs and symptoms of endometriosis after a 1-year follow-up period, 25% after 3 years and 45% after 5 years.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Prevention of recurrence? Yes we can!
What the sources say
- Not checked yetcites Evers et al., 1991
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In both cases, subjective and metabolic untoward effects would considerably undermine safety and tolerability.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Life is now!
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Study quality was not assessed.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Life is now!
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In fact, prescribing medications for a few months has no clear rationale and exposes women to extenuating recurrences of symptoms and lesions and to the risk of repetitive surgery.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Life is now!
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Maintaining that progestins and OCs may be of a little value in the prevention of endometrioma recurrence and that the use of post-operative medications may cause unnecessary side effects and cost increase seems questionable in light of recent research findings.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
hedged- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
In the paper
“which is substantially higher than the estimated costs of other chronic disorders, such as Crohn's disease ($865 million) and migraine ($13-17 billion; Rogers et al., 2009).”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Scientific glasnost
What the sources say
- Not checked yetcites Rogers et al., 2009
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“these medications are still addressed with scepticism and sometimes not even mentioned among effective therapeutic alternatives.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
In the paper
“Also DeCherney (1992) maintains that the endometriosis annual recurrence rate may be as high as 15% and that cumulative rates 40% after 3-5 years.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Prevention of recurrence? Yes we can!
What the sources say
- Not checked yetcites DeCherney, 1992
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“According to studies based on 2002 US data, the global cost of the disease (including analgesics, hormonal therapies, gynaecological consultations, hospital admissions, surgical procedures, days off-work and reduced productivity) varies between $18.8 and $22 billion per year (Gao et al., 2006;Simoens et al., 2007)”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Scientific glasnost
What the sources say
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Moreover, pain symptoms relapse exposes patients to repetitive suffering, frustration, multiple courses of medical therapy and risk of serial surgery.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Prevention of recurrence? Yes we can!
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Recently, Guo (2009) calculated that the disease relapse rate is higher than 20% at 2 years and 40 -50% at 5 years.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Prevention of recurrence? Yes we can!
What the sources say
- Not checked yetcites Guo, 2009
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The latest pills are generally the most expensive, but not necessarily the most cost-effective.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Scientific glasnost
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Not all women using progestins will be relieved from pain, not all will be satisfied with their treatment, not all will continue it and not all will avoid surgery.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“as the mechanism of action seems to be ovulation inhibition.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“should be informed in an unbiased manner, as any misinformation may expose many of them to repeated surgery and a decrease in the probability of conception.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“But at least two-thirds of them could substantially ameliorate their health-related quality of life, controlling the disease with marginal associated morbidity.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
The paper relies on this without support.
Definitive surgery for endometriosis is generally not accepted by patients wishing to preserve fertility.
“an option generally not accepted by patients wishing to preserve fertility”
The paper relies on this without support.
Publication of reports in peer-reviewed journals is the most important source of information on novel drugs for physicians who generally have limited clinical experience with the latest treatments.
“publication of reports in 'peer-reviewed' journals constitutes the most important source of information on novel drugs for physicians who generally have limited clinical experience with the latest treatments”
The paper relies on this without support.
New molecules are usually among the most costly drugs on the market.
“usually new molecules are among the most costly drugs on the market”
The paper relies on this without support.
A compound with selective properties only against the ectopic endometrial cell has not yet been synthesized.
“As a compound with selective properties only against the ectopic endometrial cell has not yet been synthesized”
The paper relies on this without support.
Medical therapies for endometriosis are not curative.
“given that medical therapies for endometriosis are not curative”
The paper relies on this without support.
Medical treatment for endometriosis does not influence reproductive performance of infertile women.
“Medical treatment for endometriosis does not influence reproductive performance of infertile women.”
The paper relies on this without support.
Dropouts are usually largely dissatisfied because of persisting pain or development of major side effects.
“In fact, dropouts are usually largely dissatisfied because of persisting pain or development of major side effects.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Finally, when hormonal treatments are to be continued for long periods, estrogen-progestins and progestins appear to be among the compounds that most favorably balance benefits, harms, and costs (30,31).”
From A stepped-care approach to symptomatic endometriosis management: A participatory research initiative (2018) · cites this paper as [31]
Citations
Cites
1 retracted
Gonadotrophin-releasing hormone analogues for pain associated with endometriosis
Prentice, A., Deary, A., Goldbeck-Wood, S., Farquhar, C., & Smith, S. (1999) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000346 · Cited by 116 · cited 1×
“…in relieving pain, generally well-tolerated, and not inferior to danazol, GnRH agonists and aromatase inhibitors (Vercellini et al., 1993, 1996; Prentice et al., 2000, 2004; Cosson et al., 2002; Petta et al., 2005; Schlaff et al., 2006; Crosignani et al., 2006b; Davis et al., 2007; Selak et…”
BackgroundRetractedGiudice, L. C. (2010) · New England Journal of Medicine · doi:10.1056/nejmcp1000274 · Cited by 1,924 · cited 1×
“Endometriosis is an estrogen-dependent chronic inflammatory disease (Giudice, 2010) that can be effectively cured by definitive surgery (Shakiba et al., 2008), an option generally not accepted by patients wishing to preserve fertility.”
BackgroundBulun, S. E. (2009) · New England Journal of Medicine · doi:10.1056/nejmra0804690 · Cited by 1,772
ESHRE guideline for the diagnosis and treatment of endometriosis
Kennedy, S., Bergqvist, A., Chapron, C., D’Hooghe, T., Dunselman, G., Greb, R., Hummelshoj, L., Prentice, A., & Saridogan, E. (2005) · Human Reproduction · doi:10.1093/humrep/dei135 · Cited by 1,584 · cited 2×
“This is acknowledged in several guidelines on the treatment of endometriosis (American College of Obstetricians and Gynecologysts, 2000; Kennedy et al., 2005; Royal College of Obstetricians and Gynaecologysts, 2006; Practice Committee of the American Society for Reproductive Medicine, 2008; Society of Obstetricians an…”
BackgroundMethodRecurrence of endometriosis and its control
Guo, S.-W. (2009) · Human Reproduction Update · doi:10.1093/humupd/dmp007 · Cited by 719 · cited 3×
“This would explain why 9% of patients do not respond to progestin treatment (Guo, 2009). by guest on Septem ber 24, 2015 http://hum rep.oxfordjournals.org/ D ow nloaded from The expression of human progesterone receptor (PR) is controlled by two promoters that direct the synthesis of mRNA…”
BackgroundStrowitzki, T., Marr, J., Gerlinger, C., Faustmann, T., & Seitz, C. (2010) · Human Reproduction · doi:10.1093/humrep/dep469 · Cited by 381 · cited 2×
“…GnRH agonists and aromatase inhibitors (Vercellini et al., 1993, 1996; Prentice et al., 2000, 2004; Cosson et al., 2002; Petta et al., 2005; Schlaff et al., 2006; Crosignani et al., 2006b; Davis et al., 2007; Selak et al., 2007; Harada et al., 2009; Ferrero et al., 2009b; Strowitzki et al., 2010a).”
BackgroundPetta, C. A., Ferriani, R. A., Abrao, M. S., Hassan, D., Rosa e Silva, J. C., Podgaec, S., & Bahamondes, L. (2005) · Human Reproduction · doi:10.1093/humrep/deh869 · Cited by 363 · cited 1×
“…not inferior to danazol, GnRH agonists and aromatase inhibitors (Vercellini et al., 1993, 1996; Prentice et al., 2000, 2004; Cosson et al., 2002; Petta et al., 2005; Schlaff et al., 2006; Crosignani et al., 2006b; Davis et al., 2007; Selak et al., 2007; Harada et al., 2009; Ferrero et al.,…”
BackgroundEndometriosis: cost estimates and methodological perspective
Simoens, S., Hummelshoj, L., & D'Hooghe, T. (2007) · Human Reproduction Update · doi:10.1093/humupd/dmm010 · Cited by 357 · cited 2×
“8 and $22 billion per year (Gao et al., 2006; Simoens et al., 2007), which is substantially higher than the estimated costs of other chronic disorders,”
BackgroundInfluentialPriorities for Endometriosis Research: Recommendations From an International Consensus Workshop
Rogers, P. A. W., D’Hooghe, T. M., Fazleabas, A., Gargett, C. E., Giudice, L. C., Montgomery, G. W., Rombauts, L., Salamonsen, L. A., & Zondervan, K. T. (2009) · Reproductive Sciences · doi:10.1177/1933719108330568 · Cited by 346
Surgical Treatment of Endometriosis: A 7-Year Follow-up on the Requirement for Further Surgery
Shakiba, K., Bena, J. F., McGill, K. M., Minger, J., & Falcone, T. (2008) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e3181758ec6 · Cited by 339 · cited 3×
“(Giudice, 2010) that can be effectively cured by definitive surgery (Shakiba et al., 2008), an option generally not accepted by patients wishing to preserve fertility.”
Background
Research works printed but not linked: 18
- 2006, Cochrane database of systematic reviews (Online), 18, CD005072
- 2005, Fertility and sterility, 81, 290
- 2008, MIDDLE EAST FERTIL SOC J, 13, 304
- 2009, Cochrane database of systematic reviews (Online), 15, CD004753
- 2008, 11, 1533
- 2007, Cochrane database of systematic reviews (Online), 18, CD001019
- 1991, The British journal of clinical practice, 45, 45
- 2009, Cochrane database of systematic reviews (Online), 8, CD007677
- 2010, Cochrane database of systematic reviews (Online), 17, CD008088
- 2003, Journal of Molecular Endocrinology, 2, 241
- 2008, Fertility and sterility, 90, S260
- 2000, Cochrane database of systematic reviews (Online), 2, CD002122
- 2004, Cochrane database of systematic reviews (Online), 2, CD000346
- 2008, 11, 1561
- 2007, Cochrane database of systematic reviews (Online), 17, CD000068
- 2010, Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obst trique et gyn cologie du Canada : JOGC, 32, S1
- 2008, American journal of obstetrics and gynecology, 198, 504
- 2004, Cochrane database of systematic reviews (Online), 3, CD003678
Cited by
Sorted by citations
Endometriosis: pathogenesis and treatment
Vercellini, P., Viganò, P., Somigliana, E., & Fedele, L. (2014) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2013.255 · Cited by 1,940
Self-citationConsensus on current management of endometriosis
Johnson, N. P., Hummelshoj, L., for the World Endometriosis Society Montpellier Consortium, Abrao, M. S., Adamson, G. D., Allaire, C., Amelung, V., Andersson, E., Becker, C., Birna Árdal, K. B., et al. (2013) · Human Reproduction · doi:10.1093/humrep/det050 · Cited by 558
Self-citationProgesterone action in endometrial cancer, endometriosis, uterine fibroids, and breast cancer
Kim, J. J., Kurita, T., & Bulun, S. E. (2013) · Endocrine Reviews · doi:10.1210/er.2012-1043 · Cited by 520
Clinical Management of Endometriosis
Falcone, T., & Lebovic, D. I. (2011) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e31822adfd1 · Cited by 264
Estrogen-progestins and progestins for the management of endometriosis
Vercellini, P., Buggio, L., Berlanda, N., Barbara, G., Somigliana, E., & Bosari, S. (2016) · Fertility and Sterility · doi:10.1016/j.fertnstert.2016.10.022 · Cited by 243
Self-citation
Metadata
- Authors
- Vercellini, P., Crosignani, P., Somigliana, E., Vigano, P., Frattaruolo, M. P., & Fedele, L.
- Affiliations
- University of Milan (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Corresponding author
- Vercellini, P.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-11-11
- Volume
- 26
- Issue
- 1
- Pages
- 3-13
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2117571760
- Semantic Scholar
- 63311710c2bb2995a9c0e275757690da0a84e5e1
- Cited by
- 180
- References
- 112
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 7 · 2021: 9 · 2020: 9 · 2019: 8 · 2018: 15 · 2017: 16 · 2016: 13 · 2015: 18 · 2014: 9 · 2013: 25 · 2012: 18
- FWCI
- 23.24
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- Human Reproduction (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- endometriosis, progestins, oral contraceptives, hormonal manipulation, endometrioma recurrence, postoperative recurrence, endometriosis-associated ovarian cancer, deep infiltrating endometriosis, pelvic pain, drug safety and tolerability
- MeSH terms
- Contraceptives, Oral, Endometriosis, Female, Humans, Drugs, Investigational, Randomized Controlled Trials as Topic, Secondary Prevention, Drug-Related Side Effects and Adverse Reactions
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