ABSTRACT
Endometriosis affects 1 in 10 women of reproductive-age. The current treatments are surgical and hormonal but have limitations, including the risk of recurrence, side effects, contraceptive action for women who desire pregnancy, and cost. New treatments include gonadotropin-releasing hormone analogues, selective progesterone (or estrogen) receptor modulators, aromatase inhibitors, immunomodulators, and antiangiogenic agents. Further research is needed into central sensitization, local neurogenesis, and the genetics of endometriosis to identify additional treatment targets. A wider range of medical options allows for the possibility of precision health and a more personalized treatment approach for women with endometriosis.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Aromatase Inhibitors/therapeutic use , Contraceptives, Oral, Hormonal/therapeutic use , Endometriosis/drug therapy , Endometrium/drug effects , Immunologic Factors/therapeutic use , Angiogenesis Inhibitors/adverse effects , Animals , Aromatase Inhibitors/adverse effects , Contraceptives, Oral, Hormonal/adverse effects , Endometriosis/diagnosis , Endometriosis/physiopathology , Endometrium/pathology , Endometrium/physiopathology , Female , Humans , Immunologic Factors/adverse effects , Treatment OutcomeABSTRACT
Endometriosis can recur after either surgical or medical therapy. Long-term medical therapy is implemented to treat symptoms or prevent recurrence. Dienogest and gonadotropin-releasing hormone (GnRH) analogues with hormone add-back therapy seem to be equally effective for long-term treatment of pain symptoms associated with endometriosis. There is insufficient evidence to support the superiority of one therapy over the other. However, add-back hormone therapy (HT) is recommended for patients using GnRH agonists. The treatment selection depends on therapeutic effectiveness, tolerability, drug cost, the physician's experience, and expected patient compliance.
Subject(s)
Contraceptives, Oral, Combined/administration & dosage , Endometriosis/drug therapy , Endometrium/drug effects , Gonadotropin-Releasing Hormone/agonists , Nandrolone/analogs & derivatives , Pelvic Pain/drug therapy , Progestins/administration & dosage , Adolescent , Adult , Age Factors , Contraceptives, Oral, Combined/adverse effects , Contraceptives, Oral, Combined/economics , Cost-Benefit Analysis , Drug Costs , Drug Therapy, Combination , Endometriosis/diagnosis , Endometriosis/economics , Endometriosis/physiopathology , Endometrium/pathology , Endometrium/physiopathology , Female , Humans , Medication Adherence , Nandrolone/administration & dosage , Nandrolone/adverse effects , Nandrolone/economics , Pelvic Pain/diagnosis , Pelvic Pain/economics , Pelvic Pain/physiopathology , Progestins/adverse effects , Progestins/economics , Recurrence , Treatment Outcome , Young AdultABSTRACT
Endometriosis is a common cause of pelvic pain in women of reproductive age. Traditional medical therapies are hormonal in nature, including estrogen-progestin contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) agonists. Other hormonal options are androgens and aromatase inhibitors, with research also suggesting a possible role for GnRH antagonists and selective progesterone receptor modulators. Other than nonsteroidal anti-inflammatories, further work is required for nonhormonal therapies such as antiangiogenic and immune-modulating drugs. Medical treatment of endometriosis can be complex, and requires consideration of side effects, the anatomic type of endometriosis, role of surgery, current infertility or future fertility desires, and other contributors to pain (e.g., central sensitization). These factors should be discussed for each patient, to ensure personalized treatment and optimal outcomes.