human
***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: OBJECTIVE Up to now limited attention has been given to the medical treatment of bowel endometriosis . This study evaluates the efficacy of aromatase inhibitors and norethisterone acetate in treating pain and gastrointestinal symptoms caused by bowel endometriosis . STUDY DESIGN This prospect i ve pilot study included six women with colorectal endometriosis ; all women had intestinal nodules infiltrating at least the muscularis propria of the bowel and did not have a stenosis of the bowel lumen > 60 % ; the patients suffered from pain and intestinal symptoms . The study subjects received letrozole ( 2.5 mg/day ) and norethisterone acetate ( 2.5 mg/day ) continuously for 6 months . The presence and intensity of symptoms were evaluated before starting the treatment , and after 3 and 6 months of treatment . RESULTS The double-drug regimen improved pain , non-menstrual pelvic pain , deep dyspareunia , dyschezia , symptoms mimicking diarrhoea-predominant irritable bowel syndrome , intestinal cramping , abdominal bloating and passage of mucus in the stools , and 67 % of the patients declared that the treatment improved their gastrointestinal symptoms . CONCLUSIONS The administration of letrozole and norethisterone acetate reduces pain and gastrointestinal symptoms of women with colorectal endometriosis , particularly when patients suffer from symptoms mimicking diarrhoea-predominant irritable bowel syndrome OBJECTIVE To examine the effect on pain and quality of life for women with all stages of endometriosis undergoing laparoscopic surgery  compared with placebo surgery . DESIGN A r and omized , blinded , crossover study . SETTING A tertiary referral unit in a district general hospital . PATIENT(S ) Thirty-nine women with histologically proven endometriosis completed the 12-month study . INTERVENTION(S ) Women were r and omized to receive initially either a diagnostic procedure ( the delayed surgical group ) or full excisional surgery ( the immediate surgery group ) . After 6 months , repeat laparoscopy was performed , with removal of any pathology present . MAIN OUTCOME MEASURE(S ) The end points were changes from baseline values of visual analogue pain scores , vali date d quality -of-life instruments ( EQ-5D and SF-12 ) , and sexual activity question naire scores . Patients and assessors of outcomes were blinded to the treatment-group assignment . RESULT ( S ) Significantly more of the 39 women operated on according to protocol reported symptomatic improvement after excisional surgery than after placebo : 16 of 20 ( 80 % ) vs. 6 of 19 ( 32 % ) ; chi(2)(1 ) = 9.3 . Other aspects of quality of life were also significantly improved 6 months after excisional surgery but not after placebo .  Progression of disease at second surgery was demonstrated for women having only an initial diagnostic procedure in 45 % of cases , with disease remaining static in 33 % and improving in 22 % of cases . Nonresponsiveness to surgery was reported in 20 % of cases . CONCLUSION ( S ) Laparoscopic excision of endometriosis is more effective than placebo at reducing pain and improving quality of life . Surgery is associated with a 30 % placebo response rate that is not dependent on severity of disease . Approximately 20 % of women do not report an improvement after surgery for endometriosis Background When aromatase inhibitors are used to treat premenopausal women with endometriosis , additional drugs should be used to effectively down-regulate gonadal estrogen bio synthesis . This r and omized prospect i ve open-label study compared the efficacy in treating pain symptoms and the tolerability of letrozole combined with either norethisterone acetate or triptorelin . Methods Women with pain symptoms caused by rectovaginal endometriosis were treated with letrozole  ( 2.5 mg/day ) and were r and omized to also receive either oral norethisterone acetate ( 2.5 mg/day ; group N ) or intramuscular injection of triptorelin ( 11.25 mg every 3 months ; group T ) . The scheduled length of treatment was 6 months . A visual analogue scale and a multidimensional categorical rating scale were used to assess the severity of pain symptoms . The volume of the endometriotic nodules was estimated by ultrasonography using virtual organ computer-aided analysis . Adverse effects of treatment were recorded . Results A total of 35 women were r and omized between the two treatment protocol s. Significantly more patients in group N rated their treatment as satisfactory or very satisfactory ( 64.7 % ) as compared to group T ( 22.2 % ; p = 0.028 ) . The intensity of both non-menstrual pelvic pain and deep dyspareunia significantly decreased during treatment in both study groups , though no statistically meaningful difference between the two groups was apparent . Reduction in the volume of endometriotic nodules was significantly greater in group T than in group N. Interruption of treatment due to adverse effects significantly differed between the groups , with 8 women in group T ( 44.4 % ) and 1 woman in group N ( 5.9 % ) interrupting treatment ( p = 0.018 ) . Similarly , 14 women included in group T ( 77.8 % ) and 6 women included in group N ( 35.3 % ) experienced adverse effects of treatment ( p = 0.018 ) . During treatment , mineral bone density significantly decreased in group T but not in group N. Conclusions Aromatase inhibitors reduce the intensity of endometriosis-related pain symptoms . Combining letrozole with oral norethisterone acetate was associated with a lower incidence of adverse effects and a lower discontinuation rate than combining letrozole with triptorelin This open-label prospect i ve study evaluated the efficacy of letrozole ( 2.5 mg/day ) combined with norethisterone acetate ( 2.5 mg/day ) in the treatment of  pain symptoms related to the presence of rectovaginal endometriosis . The treatment significantly and quickly decreased the intensity of symptoms , but pain recurred at 3-month follow-up ; five women underwent surgery during the follow-up , and histologic examination of rectovaginal nodules revealed the presence of active endometriotic lesions BACKGROUND The objective of this multicentre r and omized , controlled clinical trial was to compare the efficacy of a levonorgestrel-releasing intrauterine system ( LNG-IUS ) and a depot-GnRH-analogue in the control of endometriosis-related pain over a period of six months . METHODS Eighty-two women , 18 to 40 years of age ( mean 30 years ) , with endometriosis , dysmenorrhoea and /or CPP , were r and omized using a computer-generated system of sealed envelopes into either LNG-IUS ( n = 39 ) or GnRH analogue ( n = 43 ) treatment groups at three university centres . Daily scores of endometriosis-associated CPP were evaluated using the Visual Analogue Scale ( VAS ) , daily bleeding score was calculated from bleeding calendars , and improvement in quality of life was evaluated using the Psychological General Well-Being Index Question naire ( PGWBI ) . The pain score diary was based on the VAS in which women recorded the occurrence and intensity of pain on a daily basis . A monthly score was calculated from the result of the sum of the daily scores divided by the number of days in each observation period . RESULTS CPP decreased significantly from the first month throughout the six months of therapy with both forms of treatment and there was no difference between the groups ( P > 0.999 ) . In both treatment groups , women with stage III and IV endometriosis showed a more rapid improvement in the VAS pain score than women with stage I and II of the disease ( P < 0.002 ) . LNG-IUS users had a higher bleeding score than GnRH-analogue users at all time points of observation with 34 % and 71 % of patients in the LNG-IUS and GnRH-analogue groups , respectively , reporting no bleeding during the first treatment month , and 70 % and 98 % reporting no bleeding during the sixth month . No difference was observed between groups with reference to improvement in quality of life . CONCLUSIONS Both , the LNG-IUS and the GnRH-analogue were effective in the treatment of CPP-associated endometriosis , although no differences were observed between the two treatments . Among the additional advantages of the LNG-IUS is the fact that it does not provoke hypoestrogenism and that it requires only one medical intervention for its introduction every 5 years . This device could therefore become the treatment of choice for CPP-associated endometriosis in women who do not wish to conceive INTRODUCTION Deep infiltrating endometriosis ( DIE ) is a form of endometriosis in which the lesion penetrates for more than 5 mm under the peritoneal surface . It is a chronic disease which can impair women 's sexual function . There is a growing body of evidence supporting combined surgical/medical treatment in the management of DIE . AIMS The aims of this article are to evaluate the impact of the laparoscopic full excision of endometriosis and postoperative combined oral contraceptives ( COC ) administration on sexual function in patients with DIE and to compare sexual function outcomes of women su bmi tted to intestinal resection and nodule excision .  METHODS It is a prospect i ve cohort study in a tertiary care university hospital on 106 sexually active women , with histologically confirmed DIE , managed by laparoscopy and subsequent COC therapy for 6 months . Patients filled preoperatively and 6-month postoperatively a quality of sexual life question naire , the Sexual Health Outcomes in Women Question naire ( SHOW-Q ) and they ranked their symptom intensity using a 10-point visual analogue scale ( VAS ) . MAIN OUTCOME MEASURES Sexual function was measured through the SHOW-Q scores and pain symptoms through VAS scores . Intraoperative details , type of intervention and perioperative complications were noted . RESULTS Six months after surgery and postoperative COC treatment , a significant improvement was observed in the SHOW-Q domains of pelvic problem interference , sexual satisfaction and desire ( P<0.05 ) . Laparoscopic management of DIE did not change significantly the orgasm area of the sexual functioning ( P=0.7 ) . No significant difference was found in SHOW-Q scores between patients su bmi tted to intestinal resection and patients su bmi tted to intestinal nodule excision ( P>0.05 ) . CONCLUSIONS Sexual desire , satisfaction with sex and pelvic problem interference with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative COC therapy . No difference in sexual outcomes was detected between patients su bmi tted to intestinal resection and nodule excision OBJECTIVE To assess the impact of endometriosis on health-related quality of life ( HRQoL ) and work productivity . DESIGN Multicenter cross-sectional study with prospect i ve recruitment . SETTING Sixteen clinical centers in ten countries . PATIENT(S ) A total of 1,418 premenopausal women , aged 18 - 45 years , without a previous surgical diagnosis of endometriosis , having laparoscopy to investigate symptoms or to be sterilized .  INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Diagnostic delay , HRQoL , and work productivity . RESULT ( S ) There was a delay of 6.7 years , principally in primary care , between onset of symptoms and a surgical diagnosis of endometriosis , which was longer in centers where women received predominantly state-funded health care ( 8.3 vs. 5.5 years ) . Delay was positively associated with the number of pelvic symptoms ( chronic pelvic pain , dysmenorrhoea , dyspareunia , and heavy periods ) and a higher body mass index . Physical HRQoL was significantly reduced in affected women compared with those with similar symptoms and no endometriosis . Each affected woman lost on average 10.8 hours ( SD 12.2 ) of work weekly , mainly owing to reduced effectiveness while working . Loss of work productivity translated into significant costs per woman/week , from US$ 4 in Nigeria to US$ 456 in Italy . CONCLUSION ( S ) Endometriosis impairs HRQoL and work productivity across countries and ethnicities , yet women continue to experience diagnostic delays in primary care . A higher index of suspicion is needed to expedite specialist assessment of symptomatic women . Future research should seek to clarify pain mechanisms in relation to endometriosis severity Background Deep infiltrating endometriosis ( DIE ) can affect importantly patients ' quality of life ( QOL ) . The aim of this study is to evaluate the impact of the laparoscopic management of DIE on QOL after six months from treatment . Methods It is a prospect i ve cohort study . In a tertiary care university hospital , between April 2008 and December 2009 , 100 patients underwent laparoscopic management of DIE  and completed preoperatively and 6-months postoperatively a QOL question naire , the short form 36 ( SF-36 ) . Quality of life was measured through the SF-36 scores . Intra-operative details of disease site , number of lesions , type of intervention , period of hospital stay and peri-operative complications were noted . Results Six months postoperatively all the women had a significant improvement in every scale of the SF-36 ( p < 0,0005 ) . Among patients with intestinal DIE , significant differences in postoperative scores of SF-36 were not detected between patients su bmi tted to nodule shaving and segmental resection ( p > 0.05 ) . There was no significant 
    Output:
    
agent
Surgery and the use of drugs provided reduced pain scores in patients with endometriosis but nevertheless exhibit disadvantages , such as risk of recurrence and side effects , respectively .
However , improved quality of life in these patients has been obtained with the use of conventional treatment
***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: OBJECTIVE Up to now limited attention has been given to the medical treatment of bowel endometriosis . This study evaluates the efficacy of aromatase inhibitors and norethisterone acetate in treating pain and gastrointestinal symptoms caused by bowel endometriosis . STUDY DESIGN This prospect i ve pilot study included six women with colorectal endometriosis ; all women had intestinal nodules infiltrating at least the muscularis propria of the bowel and did not have a stenosis of the bowel lumen > 60 % ; the patients suffered from pain and intestinal symptoms . The study subjects received letrozole ( 2.5 mg/day ) and norethisterone acetate ( 2.5 mg/day ) continuously for 6 months . The presence and intensity of symptoms were evaluated before starting the treatment , and after 3 and 6 months of treatment . RESULTS The double-drug regimen improved pain , non-menstrual pelvic pain , deep dyspareunia , dyschezia , symptoms mimicking diarrhoea-predominant irritable bowel syndrome , intestinal cramping , abdominal bloating and passage of mucus in the stools , and 67 % of the patients declared that the treatment improved their gastrointestinal symptoms . CONCLUSIONS The administration of letrozole and norethisterone acetate reduces pain and gastrointestinal symptoms of women with colorectal endometriosis , particularly when patients suffer from symptoms mimicking diarrhoea-predominant irritable bowel syndrome OBJECTIVE To examine the effect on pain and quality of life for women with all stages of endometriosis undergoing laparoscopic surgery  compared with placebo surgery . DESIGN A r and omized , blinded , crossover study . SETTING A tertiary referral unit in a district general hospital . PATIENT(S ) Thirty-nine women with histologically proven endometriosis completed the 12-month study . INTERVENTION(S ) Women were r and omized to receive initially either a diagnostic procedure ( the delayed surgical group ) or full excisional surgery ( the immediate surgery group ) . After 6 months , repeat laparoscopy was performed , with removal of any pathology present . MAIN OUTCOME MEASURE(S ) The end points were changes from baseline values of visual analogue pain scores , vali date d quality -of-life instruments ( EQ-5D and SF-12 ) , and sexual activity question naire scores . Patients and assessors of outcomes were blinded to the treatment-group assignment . RESULT ( S ) Significantly more of the 39 women operated on according to protocol reported symptomatic improvement after excisional surgery than after placebo : 16 of 20 ( 80 % ) vs. 6 of 19 ( 32 % ) ; chi(2)(1 ) = 9.3 . Other aspects of quality of life were also significantly improved 6 months after excisional surgery but not after placebo .  Progression of disease at second surgery was demonstrated for women having only an initial diagnostic procedure in 45 % of cases , with disease remaining static in 33 % and improving in 22 % of cases . Nonresponsiveness to surgery was reported in 20 % of cases . CONCLUSION ( S ) Laparoscopic excision of endometriosis is more effective than placebo at reducing pain and improving quality of life . Surgery is associated with a 30 % placebo response rate that is not dependent on severity of disease . Approximately 20 % of women do not report an improvement after surgery for endometriosis Background When aromatase inhibitors are used to treat premenopausal women with endometriosis , additional drugs should be used to effectively down-regulate gonadal estrogen bio synthesis . This r and omized prospect i ve open-label study compared the efficacy in treating pain symptoms and the tolerability of letrozole combined with either norethisterone acetate or triptorelin . Methods Women with pain symptoms caused by rectovaginal endometriosis were treated with letrozole  ( 2.5 mg/day ) and were r and omized to also receive either oral norethisterone acetate ( 2.5 mg/day ; group N ) or intramuscular injection of triptorelin ( 11.25 mg every 3 months ; group T ) . The scheduled length of treatment was 6 months . A visual analogue scale and a multidimensional categorical rating scale were used to assess the severity of pain symptoms . The volume of the endometriotic nodules was estimated by ultrasonography using virtual organ computer-aided analysis . Adverse effects of treatment were recorded . Results A total of 35 women were r and omized between the two treatment protocol s. Significantly more patients in group N rated their treatment as satisfactory or very satisfactory ( 64.7 % ) as compared to group T ( 22.2 % ; p = 0.028 ) . The intensity of both non-menstrual pelvic pain and deep dyspareunia significantly decreased during treatment in both study groups , though no statistically meaningful difference between the two groups was apparent . Reduction in the volume of endometriotic nodules was significantly greater in group T than in group N. Interruption of treatment due to adverse effects significantly differed between the groups , with 8 women in group T ( 44.4 % ) and 1 woman in group N ( 5.9 % ) interrupting treatment ( p = 0.018 ) . Similarly , 14 women included in group T ( 77.8 % ) and 6 women included in group N ( 35.3 % ) experienced adverse effects of treatment ( p = 0.018 ) . During treatment , mineral bone density significantly decreased in group T but not in group N. Conclusions Aromatase inhibitors reduce the intensity of endometriosis-related pain symptoms . Combining letrozole with oral norethisterone acetate was associated with a lower incidence of adverse effects and a lower discontinuation rate than combining letrozole with triptorelin This open-label prospect i ve study evaluated the efficacy of letrozole ( 2.5 mg/day ) combined with norethisterone acetate ( 2.5 mg/day ) in the treatment of  pain symptoms related to the presence of rectovaginal endometriosis . The treatment significantly and quickly decreased the intensity of symptoms , but pain recurred at 3-month follow-up ; five women underwent surgery during the follow-up , and histologic examination of rectovaginal nodules revealed the presence of active endometriotic lesions BACKGROUND The objective of this multicentre r and omized , controlled clinical trial was to compare the efficacy of a levonorgestrel-releasing intrauterine system ( LNG-IUS ) and a depot-GnRH-analogue in the control of endometriosis-related pain over a period of six months . METHODS Eighty-two women , 18 to 40 years of age ( mean 30 years ) , with endometriosis , dysmenorrhoea and /or CPP , were r and omized using a computer-generated system of sealed envelopes into either LNG-IUS ( n = 39 ) or GnRH analogue ( n = 43 ) treatment groups at three university centres . Daily scores of endometriosis-associated CPP were evaluated using the Visual Analogue Scale ( VAS ) , daily bleeding score was calculated from bleeding calendars , and improvement in quality of life was evaluated using the Psychological General Well-Being Index Question naire ( PGWBI ) . The pain score diary was based on the VAS in which women recorded the occurrence and intensity of pain on a daily basis . A monthly score was calculated from the result of the sum of the daily scores divided by the number of days in each observation period . RESULTS CPP decreased significantly from the first month throughout the six months of therapy with both forms of treatment and there was no difference between the groups ( P > 0.999 ) . In both treatment groups , women with stage III and IV endometriosis showed a more rapid improvement in the VAS pain score than women with stage I and II of the disease ( P < 0.002 ) . LNG-IUS users had a higher bleeding score than GnRH-analogue users at all time points of observation with 34 % and 71 % of patients in the LNG-IUS and GnRH-analogue groups , respectively , reporting no bleeding during the first treatment month , and 70 % and 98 % reporting no bleeding during the sixth month . No difference was observed between groups with reference to improvement in quality of life . CONCLUSIONS Both , the LNG-IUS and the GnRH-analogue were effective in the treatment of CPP-associated endometriosis , although no differences were observed between the two treatments . Among the additional advantages of the LNG-IUS is the fact that it does not provoke hypoestrogenism and that it requires only one medical intervention for its introduction every 5 years . This device could therefore become the treatment of choice for CPP-associated endometriosis in women who do not wish to conceive INTRODUCTION Deep infiltrating endometriosis ( DIE ) is a form of endometriosis in which the lesion penetrates for more than 5 mm under the peritoneal surface . It is a chronic disease which can impair women 's sexual function . There is a growing body of evidence supporting combined surgical/medical treatment in the management of DIE . AIMS The aims of this article are to evaluate the impact of the laparoscopic full excision of endometriosis and postoperative combined oral contraceptives ( COC ) administration on sexual function in patients with DIE and to compare sexual function outcomes of women su bmi tted to intestinal resection and nodule excision .  METHODS It is a prospect i ve cohort study in a tertiary care university hospital on 106 sexually active women , with histologically confirmed DIE , managed by laparoscopy and subsequent COC therapy for 6 months . Patients filled preoperatively and 6-month postoperatively a quality of sexual life question naire , the Sexual Health Outcomes in Women Question naire ( SHOW-Q ) and they ranked their symptom intensity using a 10-point visual analogue scale ( VAS ) . MAIN OUTCOME MEASURES Sexual function was measured through the SHOW-Q scores and pain symptoms through VAS scores . Intraoperative details , type of intervention and perioperative complications were noted . RESULTS Six months after surgery and postoperative COC treatment , a significant improvement was observed in the SHOW-Q domains of pelvic problem interference , sexual satisfaction and desire ( P<0.05 ) . Laparoscopic management of DIE did not change significantly the orgasm area of the sexual functioning ( P=0.7 ) . No significant difference was found in SHOW-Q scores between patients su bmi tted to intestinal resection and patients su bmi tted to intestinal nodule excision ( P>0.05 ) . CONCLUSIONS Sexual desire , satisfaction with sex and pelvic problem interference with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative COC therapy . No difference in sexual outcomes was detected between patients su bmi tted to intestinal resection and nodule excision OBJECTIVE To assess the impact of endometriosis on health-related quality of life ( HRQoL ) and work productivity . DESIGN Multicenter cross-sectional study with prospect i ve recruitment . SETTING Sixteen clinical centers in ten countries . PATIENT(S ) A total of 1,418 premenopausal women , aged 18 - 45 years , without a previous surgical diagnosis of endometriosis , having laparoscopy to investigate symptoms or to be sterilized .  INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Diagnostic delay , HRQoL , and work productivity . RESULT ( S ) There was a delay of 6.7 years , principally in primary care , between onset of symptoms and a surgical diagnosis of endometriosis , which was longer in centers where women received predominantly state-funded health care ( 8.3 vs. 5.5 years ) . Delay was positively associated with the number of pelvic symptoms ( chronic pelvic pain , dysmenorrhoea , dyspareunia , and heavy periods ) and a higher body mass index . Physical HRQoL was significantly reduced in affected women compared with those with similar symptoms and no endometriosis . Each affected woman lost on average 10.8 hours ( SD 12.2 ) of work weekly , mainly owing to reduced effectiveness while working . Loss of work productivity translated into significant costs per woman/week , from US$ 4 in Nigeria to US$ 456 in Italy . CONCLUSION ( S ) Endometriosis impairs HRQoL and work productivity across countries and ethnicities , yet women continue to experience diagnostic delays in primary care . A higher index of suspicion is needed to expedite specialist assessment of symptomatic women . Future research should seek to clarify pain mechanisms in relation to endometriosis severity Background Deep infiltrating endometriosis ( DIE ) can affect importantly patients ' quality of life ( QOL ) . The aim of this study is to evaluate the impact of the laparoscopic management of DIE on QOL after six months from treatment . Methods It is a prospect i ve cohort study . In a tertiary care university hospital , between April 2008 and December 2009 , 100 patients underwent laparoscopic management of DIE  and completed preoperatively and 6-months postoperatively a QOL question naire , the short form 36 ( SF-36 ) . Quality of life was measured through the SF-36 scores . Intra-operative details of disease site , number of lesions , type of intervention , period of hospital stay and peri-operative complications were noted . Results Six months postoperatively all the women had a significant improvement in every scale of the SF-36 ( p < 0,0005 ) . Among patients with intestinal DIE , significant differences in postoperative scores of SF-36 were not detected between patients su bmi tted to nodule shaving and segmental resection ( p > 0.05 ) . There was no significant 
    Output:
    