***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: An open-label r and omized pilot study was conducted to evaluate the efficacy and acceptability of 6 months treatment with leuprolide in a 3-monthly versus a monthly i.m . depot injection for the relief of chronic pelvic pain in women with endometriosis . A total of 30 women aged 18 - 38 years were allocated to the 3-monthly depot arm ( n = 15 ) or to the monthly depot arm ( n = 15 ) after laparoscopic diagnosis of pelvic endometriosis .  Mean ( SD ) deep dyspareunia scores according to a 0 - 3 point verbal rating scale decreased from 1.8 ( 0.9 ) at baseline to 1.3 ( 0.7 ) at the end of treatment in the 3-monthly depot group and from 2.1 ( 1.2 ) to 1.3 ( 0.7 ) in the monthly depot group . Corresponding values in non-menstrual pain scores fell from 2.1 ( 0.6 ) to 1.1 ( 0.3 ) , and from 2.1 ( 0.8 ) to 1.2 ( 0.4 ) respectively , without statistically significant differences between the groups . Serum luteinizing hormone ( LH ) and 17 beta-oestradiol concentrations were significantly suppressed at 12 and 24 weeks compared with baseline values , without differences between the groups . The monthly depot caused a slightly more marked inhibition of serum follicle stimulating hormone ( FSH ) levels with respect to the 3-monthly preparation . Mean ( SD ) endometriosis scores at baseline and at 6-month follow-up laparoscopy were respectively 32.8 ( 25.1 ) and 12.2 ( 9.3 ) in the 3-monthly depot group and 29.0 ( 22.7 ) and 13.1 ( 15.3 ) in the monthly depot group ( paired t-test , P < 0.05 ) . Mean percentage decrease in lumbar spine bone mineral density was 5.2 % in the former and 4.9 % in the latter subjects . In the 3-monthly depot group , 13 women grade d the tolerability of their treatment schedule as " good ' compared with seven in the monthly depot group ( chi 2 = 5.40 , P = 0.02 ) OBJECTIVE To compare the efficacy and safety of goserelin depot and danazol for endometriosis . DESIGN Open , r and omized comparative trial . SETTING Multicenter European academic clinical institutions . PATIENTS A total of 307 patients with laparoscopically diagnosed endometriosis were r and omized to goserelin ( n = 204 ) or danazol ( n = 103 ) ; 249 patients underwent second look laparoscopy  ( 175 received goserelin and 74 danazol ) and were analyzed for efficacy . INTERVENTIONS A 3.6-mg depot of goserelin monthly subcutaneously or oral danazol 200 mg three times a day administered for 24 weeks . MAIN OUTCOME MEASURES Efficacy assessment s were based on changes in visible deposits at laparoscopy before and after treatment and subjective symptom scores at 4-week intervals during treatment and 8-week intervals after treatment for up to 24 weeks . Safety was assessed by adverse event reporting and clinical laboratory measures . RESULTS There were similar proportions of symptomatic ( 73 % ) and asymptomatic ( but infertile ) ( 27 % ) and comparable distribution of different severity of endometriosis r and omized to each treatment . Significantly fewer patients r and omized to goserelin ( 6.4 % ) withdrew during treatment compared with 20.4 % r and omized to danazol ( P less than 0.05 ) . There were significantly reduced visible deposits of endometriosis found post-treatment ( P less than 0.0001 ) within each group but no differences between the treatments . The mean total subjective symptoms scores remained significantly less than entry at 24 weeks post-treatment ( P less than 0.05 ) . Hypoestrogenic side effects were more common in those receiving goserelin , particularly hot flushes , but anabolic/ and rogenic side effects of weight gain and muscle cramps were more common in those receiving danazol . CONCLUSIONS The monthly administered 3.6-mg depot preparation of goserelin was highly effective at inducing resolution of endometriotic implants and relieving the symptoms of endometriosis with prevention of their return during 24 weeks follow-up in the majority of patients . However , results were not significantly different from those achieved with danazol 600 mg/d OBJECTIVE To compare the effect of a GnRH-agonist , triptorelin , versus placebo on the symptoms of endometriosis .  DESIGN A prospect i ve , r and omized , double-blind study of 6 months of treatment followed by 12 months of follow-up . SETTING Departments of Obstetrics and Gynecology at two universities and one general hospital . PATIENT(S ) Forty-nine women with symptoms of laparoscopically verified endometriosis . INTERVENTION(S ) Triptorelin depot or placebo was given every 4 weeks . Clinical evaluation , including the Duration Intensity Behavior Scale and Visual Analogue Scale for pain , was performed before the injections and up to 12 months after treatment . A control laparoscopy was performed 4 - 6 weeks after the last injection . MAIN OUTCOME MEASURE(S ) Quantitation of pain . RESULT ( S ) Twenty-four patients had active treatment and 25 received placebo .  Pain symptoms according to both scales were significantly more reduced after 2 months of triptorelin treatment compared to placebo . The extent of endometriotic lesions was reduced 50 % during triptorelin treatment and increased 17 % during placebo . The average area of endometriotic lesions was reduced 45 % during triptorelin treatment but was unchanged during placebo . Side effects , mainly hot flushes , were experienced by 80 % of the actively treated group but also by 33 % of patients in the placebo group . Because of recurrent symptoms , only five patients could be observed for 12 months after completion of treatment . CONCLUSION ( S ) Triptorelin reduces endometriotic lesions and pain to a significantly higher degree than placebo BACKGROUND The study was conducted to evaluate the cardiovascular risk markers associated with endometriosis and the influence of the levonorgestrel intrauterine system ( LNG-IUS ) compared with the GnRH analogue ( GnRHa ) leuprolide acetate on these risk markers after 6 months of treatment . STUDY DESIGN This was a r and omized , prospect i ve , open clinical study , with 44 patients with laparoscopically and histologically confirmed endometriosis . Patients were r and omized into two groups : the LNG-IUS group , composed of 22 patients who underwent LNG-IUS insertion , and the GnRHa group , composed of 22 patients who received a monthly GnRHa injection for 6 months .  Body mass index ; systolic and diastolic arterial blood pressure ; heart rate ; and laboratory cardiovascular risk markers such as interleukin-6 ( IL-6 ) , tumor necrosis factor-alpha ( TNF-alpha ) , C-reactive protein ( CRP ) , homocysteine ( HMC ) , lipid profile , total leukocytes and vascular cell adhesion molecule ( VCAM ) were measured before and 6 months after treatment . RESULTS After 6 months of treatment , a significant reduction in pain score occurred in both groups with no significant difference in improvement between the two medications evaluated . In the LNG-IUS group , from pretreatment to posttreatment period , there was a significant reduction in the levels ( mean+/-SD ) of VCAM ( 92.8+/-4.2 to 91.2+/-2.7 ng/mL , p=.04 ) , CRP ( 0.38+/-0.30 to 0.28+/-0.21 mg/dL , p=.03 ) , total cholesterol ( 247.0+/-85.0 to 180.0+/-31.0 mg/dL , p=.0002 ) , triglycerides ( 118.0+/- 76.0 to 86.5+/-41.5 mg/dL , p=.003 ) , low-density lipoprotein cholesterol ( 160.5+/-66.0 to 114.5+/-25.5 mg/dL , p=.0005 ) and high-density lipoprotein cholesterol ( 63.0+/-20.5 to 48.5+/-10.5 mg/dL , p=.002 ) . The GnRHa group showed an increase in HMC levels ( 11.5+/-2.9 to 13.0+/-2.7 mumol/L , p=.04 ) and a reduction in IL-6 levels ( 4.3+/-3.9 to 2.3+/-0.8 pg/mL , p=.005 ) , VCAM ( 94.0+/-3.8 to 92.0+/-1.6 ng/mL , p=.03 ) and total leukocytes ( 7330+/-2554 to 6350+/-1778 , p=.01 ) . In the GnRH group , the remaining variables , including lipid profile , did not show any statistical difference . CONCLUSIONS This study shows that some cardiovascular risk markers are influenced by both GnRHa and the LNG-IUS , but the latter had a greater positive impact on the lipid profile , which could lead to a favorable effect during long-term treatment Minor degrees of endometriosis have often been regarded as being of no import and hence remain untreated , but a study of the natural history of endometriosis has demonstrated that 47 % ( 95 % confidence limits , 23–71 % ) of patients ( n=35 ) given  placebo in a double‐blind , r and omized controlled trial showed progression of the disease when assessed before and after treatment by laparoscopy . The active agent , the progestogen gestrinone , was given at a dose of 2.5 mg twice weekly and result ed in an improvement of the disease ( p < 0.004 ) . Furthermore , follow‐up over 12 months showed no significant difference between those patients treated with active agent or placebo , and none between those with persistent disease and those in whom it had been obliterated . These data suggest that a diagnosis of mild endometriosis should be followed by treatment to prevent progressive disease , but that the treatment does not influence subsequent fertility . They indicate that expectant treatment has no place and that even if fertility is not an immediate requirement , active treatment should be instituted , and that the new gestogen , gestrinone is efficacious . Other treatments , such as  danazol or luteinizing hormone releasing hormone ( LHRH ) agonists , or the older contraceptive or pseudopregnancy regimens , must be set against spontaneous improvement ( in 5 of 17 patients i.e. 29 % ) or elimination ( in 4 of 17 patients i.e. 24 % ) in the placebo group . Infertile patients with mild endometriosis  have disorders of follicular and luteal function , and in vitro fertilization suggests a reduced fertilization rate . Nevertheless , these patients require active treatment if these problems are not to be compounded by adhesions , possibly leading to ovarian enclosure , that would further reduce the untreated cumulative conception rate 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 Gonadotropin releasing hormone ( GnRH ) agonists have shown to be effective in the treatment of several sex-hormone 
    Output:
    
The evidence suggested that GnRHas were more effective at symptom relief than no treatment/placebo .
Evidence was limited on optimal dosage or duration of treatment for GnRHas .
No route of administration appeared superior to another .
GnRHas appear to be more effective at relieving pain associated with endometriosis than no treatment/placebo .
There was no evidence of a difference in pain relief between GnRHas and danazol although more adverse events reported in the GnRHa groups .
There was no evidence of a difference in pain relief between GnRHas and levonorgestrel and no studies compared GnRHas with analgesics