Surgical versus low-dose progestin treatment for endometriosis-associated severe deep dyspareunia II: effect on sexual functioning, psychological status and health-related quality of life
Abstract
STUDY QUESTION: Does surgical and low-dose progestin treatment differentially affect endometriosis-associated severe deep dyspareunia in terms of sexual functioning, psychological status and health-related quality of life? SUMMARY ANSWER: Surgery and progestin treatment achieved essentially similar benefits at 12-month follow-up, but with different temporal trends. WHAT IS ALREADY KNOWN: Conservative surgery and hormonal therapies have been used independently for endometriosis-associated deep dyspareunia with inconsistent results. STUDY DESIGN, SIZE, DURATION: Patient preference, parallel cohort study with 12-month follow-up. The effect of conservative surgery at laparoscopy versus treatment with a low dose of norethisterone acetate per os (2.5 mg/day) in women with persistent/recurrent severe deep dyspareunia after first-line surgery was compared. PARTICIPANTS/MATERIALS AND SETTING, METHODS: A total of 51 patients chose repeat surgery and 103 progestin treatment. Variations in sexual function, psychological well-being and quality of life were measured by means of the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression Scale (HADS) and the Endometriosis Health Profile-30 (EHP-30). MAIN RESULTS AND THE ROLE OF CHANCE: Four women in the surgery group and 21 women in the progestin group withdrew from the study for various reasons. Total FSFI scores, anxiety and depression scores and EHP-30 scores improved immediately after surgery, but worsened with time, whereas the effect during progestin use increased more gradually, but progressively, without overall significant between-group differences at 12-month follow-up. A tendency was observed towards a slightly better total FSFI score after surgery at the end of the study period. LIMITATIONS, REASONS FOR CAUTION: Treatments were not randomly allocated, and distribution of participants as well as of dropouts between study arms was unbalanced. However, the possibility of choosing the treatment allowed assessment of the maximum potential effect size of the interventions. WIDER IMPLICATIONS OF THE FINDINGS: Both surgery and medical treatment with progestins are valuable options for improving the detrimental impact of endometriosis-associated dyspareunia on sexual functioning and quality of life. Women should be aware of the pros and cons of both options to decide which one best suits their needs. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by a research grant from the University of Milan School of Medicine (PUR number 2009-ATE-0570). None of the authors have a conflict of interest.
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In the authors' experience, significant improvements of sexual functioning as measured by the FSFI were associated with progestin monotherapy.
“In our experience, significant improvements of sexual functioning as measured by the FSFI were associated with progestin monotherapy (42,66).”
From A stepped-care approach to symptomatic endometriosis management: A participatory research initiative (2018) · cites this paper as [42]
In a patient-preference cohort of women with severe deep dyspareunia, satisfaction rate was significantly higher in progestin (NETA) group than surgery group (59% vs 43%).
“Satisfaction rate was statistically significantly higher in the progestin group (59% versus 43%).”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [16]
Numerous studies demonstrated efficacy of a reduced daily NETA dose of 2.5 mg.
“numerous studies by independent groups demonstrated the efficacy of a reduced daily dose of 2.5 mg [13-16].”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [16]
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- Authors
- Vercellini, P., Frattaruolo, M. P., Somigliana, E., Jones, G. L., Consonni, D., Alberico, D., & Fedele, L.
- Affiliations
- University of Milan (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- University of Sheffield (GB)
- Corresponding author
- Vercellini, P.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-02-26
- Volume
- 28
- Issue
- 5
- Pages
- 1221-1230
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2165599785
- Cited by
- 97
- References
- 64
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 7 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 5 · 2019: 10 · 2018: 17 · 2017: 7 · 2016: 12 · 2015: 12 · 2014: 5 · 2013: 3
- FWCI
- 12.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Università degli Studi di Milano
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- endometriosis, deep dyspareunia, conservative surgery, laparoscopic surgery, low-dose progestin, norethisterone acetate, sexual function, psychological well-being, anxiety and depression, health-related quality of life, patient preferences, treatment selection, recurrent endometriosis, hormone therapy, Female Sexual Function Index, Endometriosis Health Profile-30
- MeSH terms
- Norethindrone Acetate, Adolescent, Adult, Depression, Dyspareunia, Endometriosis, Female, Humans, Norethindrone, Laparoscopy, Progestins, Quality of Life, Surveys and Questionnaires, Time Factors, Cohort Studies, Treatment Outcome, Young Adult, Patient Preference
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