Progestins and medical treatment of endometriosis - physiology, history and society.

The transitory effect of hormonal treatment is the alleged main reason to criticize progestins (PGS) and combined pills (OP) in the managment of endometriosis. To the contrary their poor efficacy in the long run is often underlined. As a result, medical treatment is too seldom advised in endometriosis. In this article, we shall focus on the analysis of the reasons of the paucity of the medical interest given to progestins, reasons, which are not of a scientific or objective nature. The ultimate aim of this analysis is to develop arguments in favour of continuous administration of hormones as to obtain not simply an anovulation but a state of prolonged amenorrhea much more efficacious than the simple suppression of ovulation too often advised. And, with an emphasis on the fundamental role of surgery in the treatment of endometriosis, to give the greatest consideration to the specific nature of this disease, which is a chronic disease, justifying the long duration of hormonal administration.

[Endometriosis: a mysterious and incapacitating disorder]. / Reflexions à propos d'une maladie invalidante et toujours mystérieuse: l'endométriose.

Endometriosis can be a highly incapacitating disorder. The only effective treatment used to be surgery (increasingly by laparoscopy), and hormone therapy was solely used as an adjuvant. Today, thanks in particular to progress in sonography and MRI, and to the growing realization of the frequent role of psychological factors, medical treatment is becoming more commonplace. Drug therapy must be envisaged in the very long term, however, because its efficacy disappears on treatment cessation.

[Contraception during the perimenopause]. / La contraception en périménopause.

A PERIOD OF TRANSITION:The perimenopause is a key period in the life of an adult woman. It is characterised by the instability and unpredictability of ovulation and its onset, by an increase in estrogen-dependent diseases and by a reduction in the risk of pregnancy, which, when it occurs, is physically and mentally unacceptable. MANY POSSIBLE METHODS: The physician who must recommend a contraceptive method to a patient has a wide selection of methods, but is also confronted with many relative or absolute contraindications. Although estro-progestagen contraceptives at this stage in life are only contraindicated in smokers, low dose contraceptive pills would appear preferable. However, intra-uterine devices (IUD) are often chosen, of copper or containing levonorgestrel, depending on the particularities of menstruation. Vaginal contraception is more easily adopted by women during the perimenopause than in younger women, but eventual sexual problems in older partners should not be ignored. In France, because of its general anti-estrogenic properties and effects (mastodynia, premenstrual syndrome) a pure progestagen contraceptive is not officially indicated in the case of contraception alone. Conversely, the bioactive IUD is effective in women suffering from menorrhagia. FROM HORMONE CONTRACEPTIVES TO REPLACEMENT THERAPY: It is not always easy to know, in a woman using hormone contraceptives, the date of the menopause, at which time if she wants she can change to replacement therapy, but some recent modalities have permitted the relativized this aspect of the question.