Reply to: Continuous or cyclic contraceptives for endometriosis: a question still without an answer
KeywordsSystematic Review Endometriosis Eligible Study Pelvic Pain Amenorrhea
We agree with the authors that searching a single database for identifying eligible studies for a systematic review is not sufficient. This is explicitly highlighted in the PRISMA guidelines that we meticulously followed in this study. Except from searching the MEDLINE database we did also search the Scopus database, but we did not identify any additional eligible studies for our systematic review. We would like to apologize for not reporting this in the original manuscript.
Regarding the flow chart of the literature search, the 475 “irrelevant” articles were excluded because they did not satisfy our first inclusion criterion: “reporting on women with endometriosis who were treated postoperatively either with continuous or cyclic oCP”. We thank the authors for giving us the opportunity to clarify the above.
We agree with all the limitations that Troncon et al.  cite regarding the individual studies included in this systematic review. In fact we mention most of these limitations in the discussion section of our manuscript. Indeed there is a significant selection bias in the study by Vercellini et al.  because they evaluated patients who were already taking cyclic oCPs. Also, as Troncon et al. mention in the studies by Seracchioli et al. [4, 5], the control group was formed by non-users of contraceptives rather than by patients using placebo. Finally, the study by Vlahos et al.  is a non-randomized trial which did not show superiority of either regimen with regard to deep dyspareunia. However, despite the limitations of the included studies there is a growing body of evidence suggesting that the administration of oCPs in a continuous fashion following surgery for endometriosis seems to offer significant advantages as compared to the cyclic regimen. As continuous administration of oCPs is associated with amenorrhea, it is obvious that at least for women suffering with dysmenorrhea this is the most appropriate type of treatment. Furthermore, most of the studies support the notion that continuous oCP use is also beneficial in chronic non-menstrual pelvic pain, and for women with surgically treated endometriomas.
Finally, we agree with Dr. Troncon et al. that the evidence is limited and further randomized trials with adequate power are required to confirm these findings, but until then we believe that there is a clear trend in favor of the continuous regimen.
Conflict of interest