Benign Gynaecological Disorders

Addressing a range of the priorities: Commissioning brief advertised to researchers by the NIHR EME Programme

ESPriT2: A multi-centre randomised controlled trial to determine the effectiveness of laparoscopic treatment of isolated superficial peritoneal endometriosis for the management of chronic pelvic pain in women

Addressing priority 8:  NIHR research in progress

Despite thousands of surgeries annually, there is little scientific evidence as to whether surgical removal of superficial peritoneal endometriosis (SPE) improves overall symptoms and quality of life more than not surgically treating the endometriosis, or whether surgery could exacerbate symptoms, or even cause harm.  The information from this trial will allow women and gynaecologists to make an informed choice about whether to proceed immediately to surgical removal when a diagnostic laparoscopy identifies SPE. 

Deep infiltrating endometriosis: management by medical treatment versus early surgery: DIAMOND

Addressing priority 10:  NIHR research in progress

Deep endometriosis (DE) is treated in one of two ways.  Each treatment has its own benefits and potential drawbacks. The limited research that has been done in this area suggests that, for women with DE who are not considering immediate pregnancy, hormonal treatment over many months could be as effective as surgery in relieving pain, as long as the bowel is not narrowed by endometriosis. There is an urgent need for a research trial to compare medical (hormonal) management versus surgery for DE, to provide a clear and evidence based answer to this important question. 

Recurrence of Endometriosis: a randomised controlled trial of clinical and cost effectiveness of Gonadotrophin Releasing Hormone Analogues with add back hormone replacement therapy versus repeat Laparoscopic surgery (REGAL trial)

Addressing priority 10:  NIHR research in progress

Repeat surgery for endometriosis is invasive, expensive and risky, without guaranteeing a cure.  A less invasive way of shrinking endometriosis is to use a drug called gonadotrophin releasing hormone analogue (GnRHa) which temporarily stops the ovaries from producing oestrogen (the female hormone that endometriosis depends on for growth). While very effective in terms of reducing pain, this treatment is generally only used for 6 months to a year because of side effects such as hot flushes and night sweats caused by the lack of oestrogen, and concerns about osteoporosis (thinning of the bones). Recent research has shown that adding small doses of hormone replacement therapy (HRT) in women on GnRHa reduces the risk of side effects and osteoporosis whilst controlling the pain. To date there have been no attempts to compare long-term use (more than 1 year) of GnRHa with HRT to further key hole surgery to treat endometriosis. This research team will compare long-term (2 years) GnRHa with added HRT to key hole surgery to destroy or remove endometriosis in women who experience recurrence of pain after endometriosis surgery but wish to preserve their fertility.