A medical scene focusing on a woman relieved from pelvic pain, smiling with subtle elegance, with a backdrop of a hospital surgery room. Doctors discussing treatment options in the background, showing both a syringe and pill bottle to represent long-acting progestogen and contraceptive pills.
Endometriosis affects approximately one in ten women of reproductive age, causing severe pelvic pain and infertility. A study aimed to compare two hormonal therapies—long-acting progestogens (LAPs) and combined oral contraceptive pills (COCP)—to assess their effectiveness in reducing the recurrence of endometriosis-related pain after surgery.
Reducing Pain After Surgery
The PRE-EMPT trial involved 405 women from 34 UK hospitals. Participants were randomized to receive either a long-acting progestogen or a combined oral contraceptive pill. Kevin Cooper, the lead investigator, explained, “The aim was to find out which hormonal therapy is more effective in managing pain long-term after surgery.”
After three years of follow-up, researchers found that both groups experienced significant pain reduction—around 40%—compared to their pre-surgical levels. However, there was no significant difference between the two therapies in terms of overall pain reduction.
Fewer Surgeries With Progestogens
Interestingly, fewer women in the LAP group required further surgeries or second-line medical treatments. “One of the advantages of long-acting progestogens is that they require less frequent administration, which may improve adherence to treatment,” said Dr. Bhattacharya, a co-author of the study.
Of the women receiving long-acting progestogens, 73 required additional treatment, compared to 97 in the COCP group. This suggests that long-acting progestogens may help prevent the need for repeat surgeries and additional medical intervention.
Patient Preferences and Practical Considerations
The choice of treatment was often driven by patient preference, with more women opting for the levonorgestrel-releasing intrauterine system (LNG-IUS) or depot medroxyprogesterone acetate (DMPA). Dr. Cox, a key researcher, noted, “Many women prefer long-acting options because they don’t have to take daily medication.”
Despite the similar pain outcomes, women using long-acting progestogens reported more convenience due to reduced administration frequency, making it a practical choice for those seeking a low-maintenance treatment.
Long-Term Benefits
Both treatments demonstrated lasting benefits in terms of pain reduction, but the reduced risk of repeat surgeries made long-acting progestogens an attractive option for many women. Dr. Roberts remarked, “Although both treatments were effective, the potential to avoid additional surgeries makes progestogens a preferable option for some.”
This trial’s findings reassure women that both hormonal options are valid post-surgery, allowing for flexibility based on individual preferences and treatment goals. The economic implications of the treatments will be explored in a subsequent report.
Citation:
Cooper KG, Bhattacharya S, Daniels JP, Horne AW, Clark TJ, Saridogan E, et al. Long-acting progestogens versus combined oral contraceptive pill for preventing recurrence of endometriosis related pain: the PRE-EMPT pragmatic, parallel group, open label, randomised controlled trial. BMJ. 2024;385.
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