Danazol for pelvic pain associated with endometriosis

[Intervention Review]
Danazol for pelvic pain associated with endometriosis

Vanessa Selak2, Cindy Farquhar1, Andrew Prentice3, Amita A Singla4

1Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand. 2Waitemata District Health Board, Level 1, 15 Shea Terrace, Auckland, New Zealand. 3Department of Obstetrics and Gynaecology, Rosie Maternity Hospital, Cambridge, UK. 4Department of Obstetrics & Gynaecology, The Queen Elizabeth Hospital, Adelaide, Australia

Contact address: Cindy Farquhar, Obstetrics and Gynaecology, University of Auckland, FMHS Park Rd , Grafton, Auckland, 1003, New Zealand. c.farquhar@auckland.ac.nz. (Editorial group: Cochrane Menstrual Disorders and Subfertility Group.)

Cochrane Database of Systematic Reviews, Issue 2, 2009 (Status in this issue: Stable)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD000068.pub2
This version first published online: 17 October 2007 in Issue 4, 2007. Last assessed as up-to-date: 14 June 2007. (Help document - Dates and Statuses explained).

This record should be cited as: Selak V, Farquhar C, Prentice A, Singla AA. Danazol for pelvic pain associated with endometriosis. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000068. DOI: 10.1002/14651858.CD000068.pub2.
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Abstract


Background
Endometriosis is defined as the presence of endometrial tissue (stromal and glandular) outside the normal uterine cavity. Conventional medical and surgical treatments for endometriosis aim to remove or decrease the deposits of ectopic endometrium. The observation that hyper androgenic states (an excess of male hormone) induce atrophy of the endometrium has led to the use of androgens in the treatment of endometriosis. Danazol is one of these treatments. The efficacy of danazol is based on its ability to produce a high androgen and low oestrogen environment (a pseudo menopause) which results in atrophy of the endometriotic implants and thus an improvement in painful symptoms.


Objectives
To determine the effectiveness of danazol compared to placebo or no treatment in the treatment of the symptoms and signs, other than infertility, of endometriosis in women of reproductive age.


Search strategy
We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of trials (searched April 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2007), and MEDLINE (1966 to April 2007). In addition, all reference lists of included trials were searched, and relevant drug companies were contacted for details of unpublished trials.


Selection criteria
Randomised controlled trials in which danazol (alone or as adjunctive therapy) was compared to placebo or no therapy. Trials which only reported infertility outcomes were excluded.


Data collection and analysis
Only five trials met the inclusion criteria and two authors independently extracted data from these trials. All trials compared danazol to placebo. Three trials used danazol as sole therapy and three trials used danazol as an adjunct to surgery. Although the main outcome was pain improvement other data relating to laparoscopic scores and hormonal parameters were also collected.


Main results
Treatment with danazol (including adjunctive to surgical therapy) was effective in relieving painful symptoms related to endometriosis when compared to placebo. Laparoscopic scores were improved with danazol treatment (including as adjunctive therapy) when compared with either placebo or no treatment. Side effects were more commonly reported in those patients receiving danazol than for placebo.


Authors' conclusions
Danazol is effective in treating the symptoms and signs of endometriosis. However, its use is limited by the occurrence of androgenic side effects.


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Plain language summary

Danazol for pelvic pain associated with endometriosis
Danazol reduces the painful symptoms of endometriosis but has androgenic effects. Endometriosis is a painful condition where endometrial tissue grows outside the uterus. It can cause cysts and infertility. Danazol is a hormone that produces male characteristics as well as weight gain and acne. It does, however, relieve the painful symptoms of endometriosis, although the side effects can be unacceptable. The improvement was still present six months after treatment was stopped. There was some evidence that women who took danazol were satisfied with the treatment compared with women who had inactive treatment.






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