The Effectiveness of Hypnotherapy on the Pain Intensity of Endometriosis Patients Treated with Dienogest: A Pilot Double-Blind Randomized Clinical Trial

Abstract

Background: Endometriosis is a chronic disease in women of reproductive age accompanied by chronic pelvic pain and painful intercourse. It has a severe negative impact on these patients' psychosocial parameters. The noninvasive treatment of endometriosis remains challenging. Objectives: This study aimed to investigate the effectiveness of hypnotherapy on the pain intensity of endometriosis patients treated with dienogest. Methods: In this preliminary study (a pilot double-blind, randomized clinical trial), conducted from November 2021 to July 2022, 22 patients (18 to 45 years old) with endometriosis treated with dienogest in Shahid Akbar Abadi Hospital (Tehran, Iran) were enrolled. Via block randomization, they were divided into a control group and an intervention group (n = 11 each). The patients of both groups were given 2 mg of dienogest tablets daily as prescribed by the gynecologist. The main intervention involved hypnotherapy, which was administered only for the intervention group individually for 8 weekly sessions online (on WhatsApp) for 30 - 45 minutes. Dysmenorrhea, dyspareunia, and chronic pelvic pain were evaluated using the visual analog scale (VAS) at the beginning of the intervention, immediately after the intervention, and 4 weeks after the intervention in both groups. Mean, standard deviation, frequency, chi-square, Fisher's exact test, Mann-Whitney U, and Friedman test were used for data analysis. Results: Dysmenorrhea severity score in the intervention group was 6.30 ± 1.25 before the intervention, 5.50 ± 1.08 after the intervention, and 4.60 ± 0.97 during the follow-up, and the changes were significant (P < 0.001, effect size = 0.93). Dyspareunia severity score was 3.14 ± 4.50 before the intervention, 2.91 ± 4.30 after the intervention, and 2.42 ± 3.50 during the follow-up. These changes were also significant (P = 0.015, effect size = 0.41). However, the pelvic pain score did not significantly change despite the average decrease of 0.2 during the follow-up (P = 0.135). Conclusions: Hypnotherapy, along with drug treatment, was more effective in relieving endometriosis pain than drug treatment alone.