Cumulative Recurrence Rates of Endometriosis-Associated Pain after Long-Term Intramuscular Depot Medroxyprogesterone Acetate Therapy
Sopon Cheewadhanaraks MD*
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective : To determine the cumulative recurrence rates of endometriosis-associated pain after long-term intramuscular
depot medroxyprogesterone acetate (DMPA) therapy.
Material and Method: Sixty-one patients with symptomatic endometriosis, who had been treated with DMPA for 15 months
and were satisfied with the treatment, were included in the present study. Telephone questionnaires were used to collect
information including pain recurrence. Medical records were reviewed to obtain more information. Estimates of cumulative
recurrence rates of pain were calculated using the Kaplan-Meier technique and estimates of risk were computed using the
Cox proportional hazards models.
Results : The cumulative recurrence rates of pain after DMPA treatment were 18%, 28%, 41%, 46%, and 50% at months
12, 24, 36, 48, and 60, respectively. Age >30 years (hazard ratio = 4.40 [95% CI, 1.45-13.37]; p = 0.009), moderate
to severe stages of endometriosis (3.02 [1.30-7.03]; p = 0.010), and severe pain prior to treatment (7.80 [1.02-59.61];
p = 0.048) were found to be independent risk factors for the recurrence of pain.
Conclusion : Half of the patients had recurrent pain five years after DMPA treatment ended.
Keywords : Depot medroxyprogesterone acetate, Dysmenorrhea, Endometriosis, Pain, Recurrence
