Role of medical treatment of endometriosis

Simona Martone, Martone S, Troìa L, Libera Troìa, Paola Marcolongo, Marcolongo P, Stefano Luisi
Minerva obstetrics and gynecology · 2021 · vol. 73(3) , pp. 304–316 · doi:10.23736/s2724-606x.21.04784-5 · PMID:34008385 · W3163477870
Review OA: closed CC0 ⤵ 15 in-corpus citations
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This review discusses current medical treatments for endometriosis, including NSAIDs, hormonal therapies, and GnRH-agonists, and examines their efficacy, safety, and limitations for symptom management and recurrence prevention.

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Abstract

Endometriosis is a chronic benign disease that affects women of reproductive age. Medical therapy is often the first line of management for women with endometriosis in order to ameliorate symptoms or to prevent post-surgical disease recurrence. Currently, there are several medical options for the management of patients with endometriosis and long-term treatments should balance clinical efficacy (controlling pain symptoms and preventing recurrence of disease after surgery) with an acceptable safety-profile. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in the treatment of chronic inflammatory conditions, being efficacious in relieving primary dysmenorrhea. Combined oral contraceptives and progestins, available for multiple routes of administration, are commonly administered as first-line hormonal therapies. Several studies demonstrated that they succeed in improving pain symptoms in the majority of patients; moreover, they are well tolerated and not expensive. Gonadotropin-releasing hormone-agonists are prescribed when first line therapies are ineffective, not tolerated or contraindicated. Even if these drugs are efficacious in treating women not responding to COCs or progestins, they are not orally available and have a less favorable tolerability profile (needing an appropriate add-back therapy). Because few data are available on long-term efficacy and safety of aromatase inhibitors they should be reserved only for women with symptoms who are refractory to other treatments only in a research environment. Almost all of the currently available treatment options for endometriosis suppress ovarian function and are not curative. For this reason, research into new drugs is unsurprisingly demanding. Amongst the drugs currently under investigation, gonadotropin-releasing hormone antagonists have shown most promise, currently in late-stage clinical development. There is a number of potential future therapies currently tested only in vitro, in animal models of endometriosis or in early clinical studies with a small sample size. Further studies are necessary to conclude whether these treatments would be of value for the treatment of endometriosis.

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Condition tags

dysmenorrheaendometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Animals Animals Dysmenorrhea Dysmenorrhea Dysmenorrhea Female Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Hormone Antagonists Hormone Antagonists Humans Humans Progestins Progestins Progestins

Citation neighborhood (2-hop)

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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (95)

Cited by (15)

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