***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The effect of treatment with danazol was evaluated with respect to expectant management after laparoscopic conservative surgery . All patients conservatively operated at laparoscopy for stage III-IV endometriosis from July 1994 to October 1996 were requested to enter the study . Patients who underwent surgery for recurrent endometriosis were excluded from the study , as well as patients who had taken hormonal therapies before laparoscopy . Informed consent was obtained from 77 women who were r and omized after surgery to treatment with danazol 600 mg daily for 3 months ( n = 36 ) or to expectant management ( n = 41 ) . All patients were regularly followed up every 6 months for evaluation of fertility , recurrence of pain symptoms and disease . During the follow-up , six ( 55 % ) of the 11 infertile women allocated to danazol and eight ( 50 % ) of the 16 given no treatment became pregnant ( not significant ) . Moderate/severe pelvic pain recurred during follow-up in seven ( 23 % ) of the 31 women with pelvic pain allocated to the danazol group and nine ( 31 % ) of the 29 allocated to no treatment ; the respective cumulative pain recurrence rates at 12 months were 26 and 34 % ( log rank test , not significant ) . Three women ( 8.3 % ) treated with danazol and six ( 15 % ) who received no treatment had disease recurrence as demonstrated by gynaecological examination and /or pelvic ultrasonography ( not significant ) . Our results do not demonstrate a significant advantage of 3 month danazol therapy after laparoscopic surgery for stage III-IV endometriosis with respect to postoperative expectant management OBJECTIVE Patients with endometriosis were studied to investigate hormonal suppression by the gonadotropin-releasing hormone against nafarelin acetate compared with danazol . We hypothesized that the pattern , time course , and degree of gonadotropin and ovarian suppression would be different . DESIGN The study included 16 patients who were r and omized into one of three 6-month treatment protocol s. SETTING Patients were recruited from a university hospital setting . PATIENTS Eligible c and i date s were 18 to 45 years of age , with regular menses and documented pelvic endometriosis . INTERVENTION Six-month treatment protocol s included nafarelin 800 or 400 micrograms/d , or danazol 800 mg/d . MAIN OUTCOME MEASURES Serum estradiol ( E2 ) , progesterone ( P ) , luteinizing hormone ( LH ) , and follicle-stimulating hormone were determined before treatment and then monthly . Thirteen patients consented to a 12-hour hospital admission during the 5th and 6th month of treatment to determine LH pulse frequency and amplitude . RESULTS Estradiol and P were suppressed in all groups , but E2 significantly more by nafarelin than danazol ( P less than or equal to 0.01 ) . Nafarelin , 800 micrograms , significantly depressed LH pulse amplitude compared with danazol ( P less than or equal to 0.05 ) . Two patients in the nafarelin group had the administration of their medication observed , and both demonstrated single , high-amplitude pulses immediately after administration . CONCLUSION Nafarelin is a more potent LH and E2 suppressor than danazol , and the agonist effect of nafarelin may continue to provoke transient gonadotropin responses despite long-term therapeutic suppression Objective To ascertain whether the frequency of pelvic pain recurrence is reduced and time to symptoms recurrence is prolonged in women with symptomatic endometriosis undergoing conservative surgery and post‐operative hormonal therapy  compared with women treated with  surgery  only . Pregnancy rates and time to conception in women wanting children were also evaluated OBJECTIVE To further eluci date the origin and significance of serum CA-125 in pelvic endometriosis . DESIGN Retrospective . PATIENTS Ninety-seven women with endometriosis who participated in two trials : ( 1 ) open-label study on buserelin acetate  ( n = 51 ) and ( 2 ) comparative , placebo-controlled  study on nafarelin ( n = 31 ) versus danazol ( n = 15 ) ( 2:1 ratio ) . INTERVENTIONS ( 1 ) Buserelin acetate 900 micrograms/d intranasally ( IN ) ; ( 2 ) nafarelin 400 micrograms/d IN versus danazol 400 mg/d orally during 6 months . MAIN OUTCOME MEASURE(S ) Serum CA-125 and estradiol concentrations ; severity of endometriosis-related symptoms ; scores according to The American Fertility Society ( AFS ) classification for endometriosis and /or adhesions ( before and on last day of therapy ) . RESULTS Menstruation and adhesions appeared major factors influencing pretreatment serum CA-125 concentrations . Compared with nonmenstruating women without adhesions , both menses and adhesions induced a slight increase tending to significancy , whereas the elevating effect of adhesions and menses together was highly significant and more than expected . All three treatment regimens reduced CA-125 concentrations to the same extent ; cessation of therapy was followed by restoration to pretreatment concentrations . Of the AFS scores for implants and /or adhesions , only pretreatment scores for adhesions correlated significantly with CA-125 concentrations . Severity scores for endometriosis-related complaints did not correlate . CONCLUSIONS The findings indicate that adhesions play a major role in the presence of CA-125 in the systemic circulation and suggest that reductions of serum CA-125 concentrations during gonadotropin-releasing hormone agonist and danazol therapy are hormonally determined To investigate the effects of medical treatment of endometriosis on concentrations of insulin and glucagon in comparison with those of and rogens , 12 non-obese women with minimal endometriosis were r and omly allocated to receive treatment with either danazol or the gonadotropin-releasing hormone analogue , goserelin . In subjects treated with danazol , mean ( SD ) summed serum insulin ( 1.08 ( 0.22 ) nmol/l pretreatment ; 3.00 ( 1.50 ) nmol/l after treatment , p less than 0.05 ) and summed plasma glucagon ( 94 ( 21 ) pmol/l pretreatment ; 238 ( 113 ) pmol/l after treatment , p less than 0.05 ) responses to oral glucose administration increased significantly , but remained unchanged in subjects treated with goserelin . In the danazol-treated group , the mean free testosterone index increased from 3.3 ( 1.6 ) to 13.3 ( 4.2 ) ( p less than 0.01 ) , but there was no correlation between either glucagon or insulin and free testosterone index . In the goserelin-treated subjects , however , there was no change in mean free testosterone indices ( pretreatment 3.6 ( 1.0 ) , post-treatment 3.9 ( 1.8 ) . Thus , the increase in free testosterone index induced by danazol treatment is not responsible for the concomitant development of hyperinsulinaemia and hyperglucagonaemia The results of a r and omized trial to investigate the efficacy of different dosage regimens of danazol in the treatment of endometriosis indicate that for mild endometriosis 200 mg/day of danazol is adequate therapy with less severe side effects than higher dosages . However , more extensive disease requires a higher dose Danazol ( 200 mg three times a day ) and medroxyprogesterone acetate ( MPA , 100 mg a day ) were compared with placebo in the treatment of infertility of patients with endometriosis . Twenty-seven patients had medical therapy alone for 6 months , and 22 patients received it after conservative surgery . The clinical characteristics of the patients in the danazol group ( n = 18 ) , the MPA group ( n = 17 ) , and the placebo group ( n = 14 ) were comparable to each other . The follow-up time was 30 months . The cumulative pregnancy rates , 33 % in the danazol group ( n = 6 ) , 42 % in the MPA group ( n = 7 ) , and 46 % in the placebo group ( n = 6 ) , did not differ significantly from each other . The time to pregnancy after the start of therapy was 17.7 + /- 8.4 ( st and ard deviation [ SD ] ) months in the danazol group , 18.0 + /- 9.0 months in the MPA group and 10.0 + /- 5.8 months in the placebo group with no significant difference between the groups . The abortion rate was 26 % , and there was no significant difference among the groups . Cox multivariant analysis did reveal ovarian endometriosis a prognostically significant negative indicator as regards fecundation in endometriosis ( P less than 0.05 ) . In summary , correction of infertility alone does not appear to be an indication for the use of danazol or MPA in the treatment of endometriosis , and ovarian endometriotic lesions but not peritoneal ones do make a worse prognosis as regards fecundation in endometriosis A prospect i ve , double-blind , placebo-controlled study was design ed to evaluate the clinical efficacy and tolerance of danazol and high-dose medroxyprogesterone acetate ( MPA ) in the treatment of mild-moderate endometriosis . After laparoscopical confirmation of endometriosis , 59 patients were r and omized to receive danazol ( 200 mg 3 times daily ) , MPA ( 100 mg daily ) or placebo for 6 months . Clinical examinations were done before and 1 , 3 , 6 and 12 months after the beginning of the study , and a 2nd laparoscopy 6 months after termination of the medication . Eighteen patients in the danazol  group , 16 in the  MPA group and 17 in the placebo group completed the trial . Total or partial resolution of peritoneal implants was observed in 60 % of the patients receiving danazol and in 63 % of the patients receiving MPA . In the placebo group , resolution was observed in 18 % , while the size of the implants was estimated to be increased in 23 % of the patients . In relation to placebo , danazol and MPA significantly alleviated endometriosis-associated pelvic pain , lower back pain and defecation pain , but they did not differ from each other in these actions . The appearance of acne , muscle cramps , edema , weight gain and spotting bleeding complicated MPA treatment . The present results indicate that because of good efficacy and tolerance , high-dose MPA is a useful alternative in the hormonal treatment of endometriosis OBJECTIVE To evaluate histologic and ultrastructural changes of the vaginal mucosa in patients given buserelin acetate or danazol treatment for endometriosis . DESIGN Controlled clinical study . SETTING Infertility clinic of an academic unit . PATIENTS Infertile women with endometriosis r and omized to receive buserelin acetate or danazol and undergoing vaginal biopsies during treatment were selected . INTERVENTIONS Buserelin acetate was administered IN 400 micrograms three times per day and danazol orally 600 mg/d . Vaginal biopsies were performed baseline and at 3 and 6 months of treatment , and specimens were examined by light microscopy and scanning electron microscopy . 17 beta-Estradiol and P levels were determined in each patient at the time of each biopsy . MAIN OUTCOME MEASURE Structural and ultrastructural patterns of vaginal mucosa after 3 and 6 months of treatment . RESULTS Buserelin acetate treatment induced early , marked hypotrophy of the vaginal mucosa with aspects typical of the menopause . The modifications caused by danazol occurred mainly in the intermediate layer , which was weakly hypotrophic only at the end of the treatment . CONCLUSION Vaginal mucosa undergoes constant and well-defined modifications during both buserelin acetate and danazol treatment for endometriosis . The modifications are compatible with the biological effects of the drugs A total of 62 infertile women with a laparoscopic diagnosis of endometriosis were allocated r and omly to two treatment groups , one of which ( 32 patients ) received oral danazol 600 micrograms/day and the other ( 30 patients ) received intranasal buserelin 1200 micrograms/day for 6 months . Suppression of serum levels of estradiol was greater with the gonadotropin-releasing hormone agonist treatment . Pain symptoms improved markedly during treatment in both groups . At the end of treatment a repeat laparoscopy was performed only in the patients who agreed to it ( 12 in the buserelin group and 13 in the danazol group ) , and it did not reveal significant differences in the effects of the two treatments on the endometriotic implants . All of the patients were followed up for at least 12 months , during which pregnancy was attempted . At 18 months the cumulative pregnancy rate was 48 % in the patients treated with buserelin and 43 % in those treated with danazol .  Pain recurrence was observed in about half of the patients in each group 1 year after treatment suspension . The side effects were more frequent and more severe in the danazol-treated patients , whereas those given buserelin generally reported only symptoms of hypoestrogenism . The 
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Their consistency in showing no treatment benefit suggests that this group of interventions is ineffective .
Again these data were homogeneous and suggest no significant treatment benefit in terms of pregnancy rate .
REVIEW ER 'S CONCLUSIONS Given the significant period of amenorrhea associated with ovulation suppression , the lack of treatment benefit demonstrated and the adverse effects commonly associated with these treatments , ovulation suppression can not be recommended as a st and ard therapy for endometriosis-associated infertility