Medical Management of Endometriosis

Botros R. M. B. Rizk, Mary George Nawar, Christine B. Rizk, David B. Rizk
In: Infertility and Assisted Reproduction · 2008 · pp. 309–317 · doi:10.1017/cbo9780511547287.036 · W1641026950
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This paper reviews medical treatments for endometriosis including progestogens, GnRH agonists/antagonists, progesterone receptor modulators, aromatase inhibitors, antiangiogenesis agents, and NSAIDs.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This chapter reviews the medical management of endometriosis, contrasting historical high-dose androgen/progestin approaches with modern hormonal therapies and discussing emerging trial areas. It frames treatment largely around effects of hormones and therapeutics on the in situ endometrium, while emphasizing that ectopic endometriotic tissue differs due to aberrant gene expression that alters local estrogen metabolism and progesterone signaling, including defects in enzymes and altered receptor isoform expression, plus upregulation of aromatase and matrix metalloproteinases. The chapter notes that medical therapy is not curative per se and highlights a limitation that medical treatments are not used for infertility associated with endometriosis except for downregulation prior to IVF in advanced disease. This paper is centrally about endometriosis—specifically medical hormonal management for endometriosis-associated pelvic pain and related molecular mechanisms.

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Abstract

The successful treatment of endometriosis-associated symptoms typically requires surgical as well as medical intervention. Progestogens are efficacious and inexpensive treatment of pelvic endometriosis. A variety of medications have been used as add-back therapy in addition to gonadotrophin-releasing hormone (GnRH) agonist for treatment of endometriosis which includes progestogen alone, progestogen and estrogen combination, or progestogen and bisphosphonates. GnRH antagonists have been used for the treatment of pelvic endometriosis; however, they have not been as widely accepted as GnRH agonists. Selective progesterone receptor modulators introduce a new dimension in the medical treatment of endometriosis. Aromatase inhibitors which inhibit estrogen production in endometriotic implants are an attractive option for the management of endometriosis. Antiangiogenesis therapy has been investigated in rodents, demonstrated that angiostatic agents prevent the development of endometriosis-like lesions in the chicken chorioallantoic membrane. Nonsteroidal inflammatory drugs are very helpful in pelvic pain and dysmenorrhea associated with endometriosis.

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Condition tags

endometriosisdysmenorrhea

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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