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 To compare the efficacy and safety of SC depot medroxyprogesterone acetate ( DMPA-SC 104 ) with that of leuprolide acetate in treatment of endometriosis . DESIGN Phase 3 , multicenter , r and omized , evaluator-blinded , comparator-controlled trial . SETTING Clinical trial sites in Canada and United States . PATIENT(S ) Two hundred seventy-four women with surgically diagnosed endometriosis . INTERVENTION(S ) Intramuscular injections of DMPA-SC ( 104 mg ) or leuprolide acetate ( 11.25 mg ) , given every 3 months for 6 months , with 12 months of posttreatment follow-up . MAIN OUTCOME MEASURE(S ) Reduction in five endometriosis symptoms or signs ( dysmenorrhea , dyspareunia , pelvic pain , pelvic tenderness , pelvic in duration ) ; change in bone mineral density ( BMD ) , hypoestrogenic symptoms , bleeding , and weight . RESULT ( S ) The depot medroxyprogesterone acetate given SC was statistically equivalent to leuprolide in reducing four of five endometriosis symptoms or signs at the end of treatment ( month 6 ) and in reducing all five symptoms after 12 months ' follow-up ( month 18 ) . Patients in the  DMPA-SC 104  group showed significantly less BMD loss than did leuprolide  patients at month 6 , with scores returning to baseline at 12 months ' follow-up . No statistically significant differences in median weight changes were observed between groups . Compared with leuprolide , DMPA-SC 104 was associated with fewer hypoestrogenic symptoms but more irregular bleeding . CONCLUSION ( S ) Efficacy of DMPA-SC 104 was equivalent to that of leuprolide for reducing endometriosis-associated pain , with less impact on BMD and fewer hypoestrogenic side effects but more bleeding OBJECTIVE To evaluate the efficacy of continuous oral contraceptive ( OC ) use versus the usual cyclic fashion in the recurrence of endometriosis-related symptoms after surgery . DESIGN Prospect i ve cohort trial involving patients in two tertiary care units . SETTING Academic institution in collaboration with a private hospital . PATIENT(S ) 356 patients underwent surgical treatment by laparoscopy for symptomatic endometriosis . INTERVENTION(S ) After surgical treatment for endometriosis , patients offered 6-month course of cyclic OC ( including a 7-day pill-free period ) or continuous OC . MAIN OUTCOME MEASURE(S ) Recurrence rate of endometriosis-related symptoms and endometriomas after fertility-sparing surgery . RESULT ( S ) Out of 356 patients , 167 were placed on the usual cyclic OC course  and 85 on  continuous OC for a minimum of 6 months . The continuous OC group experienced a statistically significant reduction in recurrence rates for endometrioma , dysmenorrhea , and non-menstrual pelvic pain as compared with the cyclic OC group . There was no reduction in the recurrence of dyspareunia between the two groups . CONCLUSION ( S ) After surgical treatment of endometriosis , the use of both cyclic and continuous OC improves pain symptoms when compared with preoperative scores . Continuous OC appears to be associated with a reduced recurrence rate for dysmenorrhea , non-menstrual pelvic pain , and endometrioma but not for dyspareunia as compared with cyclic OC STUDY OBJECTIVE To establish the crude effects of danazol and gonadotropin-releasing hormone ( GnRH ) analogs in the management of endometriosis .  DESIGN Prospect i ve case-control study . SETTING Unit of the Pathophysiology of Reproduction outpatient department . PATIENTS Two groups of 110 women each with endometriosis ( American Fertility Society score 1 - 3 ) who received danazol and GnRH analogs , and a control group who did not receive any drugs . INTERVENTIONS Women in the treatment groups received danazol 200 mg every 8 hours for 6 months , or a different GnRH agonist at st and ard dosages for 6 months . Laparoscopy was performed twice , at the time of diagnosis and just before the end of treatment ( or no therapy for controls ) . Surgical treatment of the implants was performed at the second laparoscopy . MEASUREMENTS AND MAIN RESULTS Sample s of both eutopic and ectopic endometrium were collected during both laparoscopies . Both danazol and GnRH agonists were useful in reducing the AFS scores to inactive endometriotic implants , and there were no significant differences between the effects ( p < 0.001 ) . Fibrosis was found after 6 months of observation in the implants in one control woman ( 0.9 % ) , in 20 patients ( 18.2 % ) treated with danazol ( p < 0.001 vs controls ) , and in 4 patients ( 3.6 % ) treated with GnRH agonists ( NS vs controls ) . A correlation between a clinical diagnosis of AFS score zero and histologic features of fibrosis in the ectopic specimens after therapies was observed in 28 % of women , with poor agreement ( k = 0.07 ) . CONCLUSIONS Fibrosis , which represent the absence of endometrial cells within the specimens of endometriotic lesions or eutopic endometrium , did not appear in eutopic endometria but it was found in some endometriotic implants . Danazol and GnRH agonists reduced the clinical AFS scores of endometriosis , but their histologic effects in completely and permanently eliminating endometriotic implants were unacceptable In the present nonr and omized pilot study we determined the role of the vaginally administered aromatase inhibitor anastrozole ( 0.25 mg anastrozole/d for 6 months ) in the treatment of women with histologically proven rectovaginal endometriosis . In a series of 10 patients , dysmenorrhea , physical and social functioning , but not chronic pelvic pain and dyspareunia , improved during therapy OBJECTIVE To evaluate the efficacy and tolerability of a contraceptive vaginal ring and transdermal patch in the treatment of  endometriosis-associated pain .  DESIGN Patient preference cohort study . SETTING Academic center . PATIENT(S ) Two-hundred and seven women with recurrent moderate or severe pelvic pain after conservative surgery for symptomatic endometriosis . INTERVENTION(S ) Continuous , 12-month treatment with a vaginal ring supplying 15 mcg of ethinyl E and 120 mcg of etonogestrel per day or a transdermal system delivering 20 mcg of ethinyl E and 150 mcg norelgestromin per day . MAIN OUTCOME MEASURE(S ) Satisfaction with treatment . RESULT ( S ) One-hundred and twenty-three women preferred the ring , and 84 preferred the patch . Forty-four ring users ( 36 % ) and 51 patch users ( 61 % ) withdrew . Thirty-six of 79 subjects ( 46 % ) in the ring group and 14 of 33 ( 42 % ) in the patch group shifted from continuous to cyclic use because of irregular bleeding . Pain symptoms were reduced by both treatments , with the ring being more effective than the patch in patients with rectovaginal lesions . According to an intention-to-treat analysis , 88 of 123 ring users ( 72 % ) and 40 of 84 patch users ( 48 % ) were satisfied with the treatment received . CONCLUSION ( S ) Patients who preferred the ring were significantly more likely to be satisfied and to comply with treatment than those who chose the patch . Both systems were associated with poor bleeding control when used continuously OBJECTIVE To evaluate postoperative long-term cyclic and continuous administration of combined oral contraceptive ( OC ) pills in preventing endometriosis-related pain recurrence . DESIGN Prospect i ve , r and omized , controlled trial . SETTING Tertiary care university hospital . PATIENT(S ) Three hundred eleven women who underwent laparoscopic excision for symptomatic ovarian endometrioma . INTERVENTION(S ) Patients were r and omly divided into three groups : nonuser group receiving no therapy , and cyclic user group and continuous user group receiving low-dose , monophasic OC pills for 24 months in either cyclic or continuous administration . MAIN OUTCOME MEASURE(S ) Presence and intensity of dysmenorrhea , dyspareunia , and chronic pelvic pain were assessed by a 10-point visual analogue scale ( VAS ) at 6 , 12 , 18 , and 24 months postoperatively . RESULT ( S ) A significant reduction in recurrence rate and VAS scores for dysmenorrhea was evident in the continuous users versus the other groups at 6 months , and in cyclic users versus nonusers at 18 months postoperatively . No significant differences in recurrence rate and VAS scores for dyspareunia and chronic pelvic pain were demonstrated among the groups . The increase of VAS scores from 6 - 24 months during the study period for dysmenorrhea , dyspareunia , and chronic pelvic pain was significantly higher in nonusers than in the other groups . CONCLUSION ( S ) Long-term postoperative use of OC pills can reduce the frequency and the severity of recurrent endometriosis-related dysmenorrhea In a large , double‐blind , multicentre study , 269 patients with confirmed endometriosis were r and omly allocated to receive either danazol ( 200 mg twice daily ; n= 137 ) or gestrinone ( 2.5 mg twice weekly ; n= 132 ) for 6 months . The two groups were comparable in terms of the staging of endometriosis by the American Fertility Society ( 1979 ) score . After the sixth month of treatment , repeat laparoscopy was performed . Clinical assessment , haematological and biochemical investigations were carried out during the 6 months of treatment and for a further 12 months ' follow‐up and are compared between the two groups . A total of 15 patients from the gestrinone group , including four patients with hirsutism , and 17 patients from the danazol group , including six patients with headache , withdrew because of adverse symptoms . An additional 22 patients , including 10 from the gestrinone group and 12 from the danazol group withdrew because of lack of efficacy , pregnancy , elevated hepatic function tests or for reasons unrelated to the trial . Total American Fertility Society scoring showed an improvement of 73.3 % in 101 patients receiving gestrinone and 72.7 % in 99 patients receiving danazol . The results showed a significant reduction in the severity of dysmenorrhoea by the third month in the danazol group and at 6 months in both groups . There was a significant ( P < 0.001 ) increase in weight observed in both groups during treatment . Overall , the tolerability  of danazol and gestrinone was good ; however , significantly more patients with gestrinone complained of hirsutism while significantly more with danazol complained of leg cramps . During the 12 months of follow‐up , mild , moderate or severe degrees of lower abdominal pain , dysmenorrhoea and deep dyspareunia all fluctuated , with no statistically significant increase in frequency in either group BACKGROUND Dienogest is a selective progestin that has been investigated in a clinical trial programme for the treatment of endometriosis . The current non-inferiority trial compared the efficacy and safety of dienogest against leuprolide acetate ( LA ) for treating the pain associated with endometriosis . METHODS Patients with confirmed endometriosis were r and omized to treatment with dienogest ( 2 mg/day , orally ) or LA ( 3.75 mg , depot i.m . injection , every 4 weeks ) for 24 weeks . The primary efficacy variable was absolute change in pelvic pain from baseline to end of treatment , assessed by visual analogue scale ( VAS ) . Safety variables included adverse event profile , laboratory parameters , bone mineral density ( BMD ) , bone markers and bleeding patterns . RESULTS A total of 252 women were r and omized to treatment with dienogest ( n = 124 ) or LA ( n = 128 ) ; 87.9 and 93.8 % of the respective groups completed the trial . Absolute reductions in VAS score from baseline to Week 24 were 47.5 mm with dienogest and 46.0 mm with LA , demonstrating the equivalence of dienogest relative to LA .  Hypoestrogenic effects ( e.g. hot flushes ) were reported less frequently in the dienogest group . As expected , bleeding episodes were suppressed less with dienogest than with LA . Changes in mean lumbar BMD between screening and final visit were + 0.25 % with dienogest and -4.04 % with LA subgroups ( P = 0.0003 ) . Markers of bone resorption increased with LA but not dienogest . CONCLUSIONS Dienogest 2 mg/day orally demonstrated equivalent efficacy to depot LA at st and ard dose in relieving the pain associated with endometriosis , although offering advantages in safety and tolerability OBJECTIVE To evaluate the effectiveness of a levonorgestrel-releasing IUD as therapy for endometriosis of the rectovaginal septum . DESIGN Prospect i ve therapeutic non-r and omized , self-controlled clinical trial analyzing changes in pain symptoms and 
    Output:
    
agent
( S ) Few studies of medical therapies for endometriosis report outcomes that are relevant to patients , and many women gain only limited or intermittent benefit from 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 To compare the efficacy and safety of SC depot medroxyprogesterone acetate ( DMPA-SC 104 ) with that of leuprolide acetate in treatment of endometriosis . DESIGN Phase 3 , multicenter , r and omized , evaluator-blinded , comparator-controlled trial . SETTING Clinical trial sites in Canada and United States . PATIENT(S ) Two hundred seventy-four women with surgically diagnosed endometriosis . INTERVENTION(S ) Intramuscular injections of DMPA-SC ( 104 mg ) or leuprolide acetate ( 11.25 mg ) , given every 3 months for 6 months , with 12 months of posttreatment follow-up . MAIN OUTCOME MEASURE(S ) Reduction in five endometriosis symptoms or signs ( dysmenorrhea , dyspareunia , pelvic pain , pelvic tenderness , pelvic in duration ) ; change in bone mineral density ( BMD ) , hypoestrogenic symptoms , bleeding , and weight . RESULT ( S ) The depot medroxyprogesterone acetate given SC was statistically equivalent to leuprolide in reducing four of five endometriosis symptoms or signs at the end of treatment ( month 6 ) and in reducing all five symptoms after 12 months ' follow-up ( month 18 ) . Patients in the  DMPA-SC 104  group showed significantly less BMD loss than did leuprolide  patients at month 6 , with scores returning to baseline at 12 months ' follow-up . No statistically significant differences in median weight changes were observed between groups . Compared with leuprolide , DMPA-SC 104 was associated with fewer hypoestrogenic symptoms but more irregular bleeding . CONCLUSION ( S ) Efficacy of DMPA-SC 104 was equivalent to that of leuprolide for reducing endometriosis-associated pain , with less impact on BMD and fewer hypoestrogenic side effects but more bleeding OBJECTIVE To evaluate the efficacy of continuous oral contraceptive ( OC ) use versus the usual cyclic fashion in the recurrence of endometriosis-related symptoms after surgery . DESIGN Prospect i ve cohort trial involving patients in two tertiary care units . SETTING Academic institution in collaboration with a private hospital . PATIENT(S ) 356 patients underwent surgical treatment by laparoscopy for symptomatic endometriosis . INTERVENTION(S ) After surgical treatment for endometriosis , patients offered 6-month course of cyclic OC ( including a 7-day pill-free period ) or continuous OC . MAIN OUTCOME MEASURE(S ) Recurrence rate of endometriosis-related symptoms and endometriomas after fertility-sparing surgery . RESULT ( S ) Out of 356 patients , 167 were placed on the usual cyclic OC course  and 85 on  continuous OC for a minimum of 6 months . The continuous OC group experienced a statistically significant reduction in recurrence rates for endometrioma , dysmenorrhea , and non-menstrual pelvic pain as compared with the cyclic OC group . There was no reduction in the recurrence of dyspareunia between the two groups . CONCLUSION ( S ) After surgical treatment of endometriosis , the use of both cyclic and continuous OC improves pain symptoms when compared with preoperative scores . Continuous OC appears to be associated with a reduced recurrence rate for dysmenorrhea , non-menstrual pelvic pain , and endometrioma but not for dyspareunia as compared with cyclic OC STUDY OBJECTIVE To establish the crude effects of danazol and gonadotropin-releasing hormone ( GnRH ) analogs in the management of endometriosis .  DESIGN Prospect i ve case-control study . SETTING Unit of the Pathophysiology of Reproduction outpatient department . PATIENTS Two groups of 110 women each with endometriosis ( American Fertility Society score 1 - 3 ) who received danazol and GnRH analogs , and a control group who did not receive any drugs . INTERVENTIONS Women in the treatment groups received danazol 200 mg every 8 hours for 6 months , or a different GnRH agonist at st and ard dosages for 6 months . Laparoscopy was performed twice , at the time of diagnosis and just before the end of treatment ( or no therapy for controls ) . Surgical treatment of the implants was performed at the second laparoscopy . MEASUREMENTS AND MAIN RESULTS Sample s of both eutopic and ectopic endometrium were collected during both laparoscopies . Both danazol and GnRH agonists were useful in reducing the AFS scores to inactive endometriotic implants , and there were no significant differences between the effects ( p < 0.001 ) . Fibrosis was found after 6 months of observation in the implants in one control woman ( 0.9 % ) , in 20 patients ( 18.2 % ) treated with danazol ( p < 0.001 vs controls ) , and in 4 patients ( 3.6 % ) treated with GnRH agonists ( NS vs controls ) . A correlation between a clinical diagnosis of AFS score zero and histologic features of fibrosis in the ectopic specimens after therapies was observed in 28 % of women , with poor agreement ( k = 0.07 ) . CONCLUSIONS Fibrosis , which represent the absence of endometrial cells within the specimens of endometriotic lesions or eutopic endometrium , did not appear in eutopic endometria but it was found in some endometriotic implants . Danazol and GnRH agonists reduced the clinical AFS scores of endometriosis , but their histologic effects in completely and permanently eliminating endometriotic implants were unacceptable In the present nonr and omized pilot study we determined the role of the vaginally administered aromatase inhibitor anastrozole ( 0.25 mg anastrozole/d for 6 months ) in the treatment of women with histologically proven rectovaginal endometriosis . In a series of 10 patients , dysmenorrhea , physical and social functioning , but not chronic pelvic pain and dyspareunia , improved during therapy OBJECTIVE To evaluate the efficacy and tolerability of a contraceptive vaginal ring and transdermal patch in the treatment of  endometriosis-associated pain .  DESIGN Patient preference cohort study . SETTING Academic center . PATIENT(S ) Two-hundred and seven women with recurrent moderate or severe pelvic pain after conservative surgery for symptomatic endometriosis . INTERVENTION(S ) Continuous , 12-month treatment with a vaginal ring supplying 15 mcg of ethinyl E and 120 mcg of etonogestrel per day or a transdermal system delivering 20 mcg of ethinyl E and 150 mcg norelgestromin per day . MAIN OUTCOME MEASURE(S ) Satisfaction with treatment . RESULT ( S ) One-hundred and twenty-three women preferred the ring , and 84 preferred the patch . Forty-four ring users ( 36 % ) and 51 patch users ( 61 % ) withdrew . Thirty-six of 79 subjects ( 46 % ) in the ring group and 14 of 33 ( 42 % ) in the patch group shifted from continuous to cyclic use because of irregular bleeding . Pain symptoms were reduced by both treatments , with the ring being more effective than the patch in patients with rectovaginal lesions . According to an intention-to-treat analysis , 88 of 123 ring users ( 72 % ) and 40 of 84 patch users ( 48 % ) were satisfied with the treatment received . CONCLUSION ( S ) Patients who preferred the ring were significantly more likely to be satisfied and to comply with treatment than those who chose the patch . Both systems were associated with poor bleeding control when used continuously OBJECTIVE To evaluate postoperative long-term cyclic and continuous administration of combined oral contraceptive ( OC ) pills in preventing endometriosis-related pain recurrence . DESIGN Prospect i ve , r and omized , controlled trial . SETTING Tertiary care university hospital . PATIENT(S ) Three hundred eleven women who underwent laparoscopic excision for symptomatic ovarian endometrioma . INTERVENTION(S ) Patients were r and omly divided into three groups : nonuser group receiving no therapy , and cyclic user group and continuous user group receiving low-dose , monophasic OC pills for 24 months in either cyclic or continuous administration . MAIN OUTCOME MEASURE(S ) Presence and intensity of dysmenorrhea , dyspareunia , and chronic pelvic pain were assessed by a 10-point visual analogue scale ( VAS ) at 6 , 12 , 18 , and 24 months postoperatively . RESULT ( S ) A significant reduction in recurrence rate and VAS scores for dysmenorrhea was evident in the continuous users versus the other groups at 6 months , and in cyclic users versus nonusers at 18 months postoperatively . No significant differences in recurrence rate and VAS scores for dyspareunia and chronic pelvic pain were demonstrated among the groups . The increase of VAS scores from 6 - 24 months during the study period for dysmenorrhea , dyspareunia , and chronic pelvic pain was significantly higher in nonusers than in the other groups . CONCLUSION ( S ) Long-term postoperative use of OC pills can reduce the frequency and the severity of recurrent endometriosis-related dysmenorrhea In a large , double‐blind , multicentre study , 269 patients with confirmed endometriosis were r and omly allocated to receive either danazol ( 200 mg twice daily ; n= 137 ) or gestrinone ( 2.5 mg twice weekly ; n= 132 ) for 6 months . The two groups were comparable in terms of the staging of endometriosis by the American Fertility Society ( 1979 ) score . After the sixth month of treatment , repeat laparoscopy was performed . Clinical assessment , haematological and biochemical investigations were carried out during the 6 months of treatment and for a further 12 months ' follow‐up and are compared between the two groups . A total of 15 patients from the gestrinone group , including four patients with hirsutism , and 17 patients from the danazol group , including six patients with headache , withdrew because of adverse symptoms . An additional 22 patients , including 10 from the gestrinone group and 12 from the danazol group withdrew because of lack of efficacy , pregnancy , elevated hepatic function tests or for reasons unrelated to the trial . Total American Fertility Society scoring showed an improvement of 73.3 % in 101 patients receiving gestrinone and 72.7 % in 99 patients receiving danazol . The results showed a significant reduction in the severity of dysmenorrhoea by the third month in the danazol group and at 6 months in both groups . There was a significant ( P < 0.001 ) increase in weight observed in both groups during treatment . Overall , the tolerability  of danazol and gestrinone was good ; however , significantly more patients with gestrinone complained of hirsutism while significantly more with danazol complained of leg cramps . During the 12 months of follow‐up , mild , moderate or severe degrees of lower abdominal pain , dysmenorrhoea and deep dyspareunia all fluctuated , with no statistically significant increase in frequency in either group BACKGROUND Dienogest is a selective progestin that has been investigated in a clinical trial programme for the treatment of endometriosis . The current non-inferiority trial compared the efficacy and safety of dienogest against leuprolide acetate ( LA ) for treating the pain associated with endometriosis . METHODS Patients with confirmed endometriosis were r and omized to treatment with dienogest ( 2 mg/day , orally ) or LA ( 3.75 mg , depot i.m . injection , every 4 weeks ) for 24 weeks . The primary efficacy variable was absolute change in pelvic pain from baseline to end of treatment , assessed by visual analogue scale ( VAS ) . Safety variables included adverse event profile , laboratory parameters , bone mineral density ( BMD ) , bone markers and bleeding patterns . RESULTS A total of 252 women were r and omized to treatment with dienogest ( n = 124 ) or LA ( n = 128 ) ; 87.9 and 93.8 % of the respective groups completed the trial . Absolute reductions in VAS score from baseline to Week 24 were 47.5 mm with dienogest and 46.0 mm with LA , demonstrating the equivalence of dienogest relative to LA .  Hypoestrogenic effects ( e.g. hot flushes ) were reported less frequently in the dienogest group . As expected , bleeding episodes were suppressed less with dienogest than with LA . Changes in mean lumbar BMD between screening and final visit were + 0.25 % with dienogest and -4.04 % with LA subgroups ( P = 0.0003 ) . Markers of bone resorption increased with LA but not dienogest . CONCLUSIONS Dienogest 2 mg/day orally demonstrated equivalent efficacy to depot LA at st and ard dose in relieving the pain associated with endometriosis , although offering advantages in safety and tolerability OBJECTIVE To evaluate the effectiveness of a levonorgestrel-releasing IUD as therapy for endometriosis of the rectovaginal septum . DESIGN Prospect i ve therapeutic non-r and omized , self-controlled clinical trial analyzing changes in pain symptoms and 
    Output:
    