Treatment strategies for endometriosis

Allison K Rodgers, Tommaso Falcone
Expert opinion on pharmacotherapy · 2008 · vol. 9(2) , pp. 243–255 · doi:10.1517/14656566.9.2.243 · PMID:18201147 · W2000194898
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This review examines current surgical and medical treatment options for endometriosis, noting hormonal suppressive therapies and NSAIDs/oral contraceptives as initial approaches with varying efficacy and recurrence rates.

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Abstract

BACKGROUND: Endometriosis is a common chronic disease that causes symptoms of pain and infertility. The pain syndrome can be quite incapacitating. The pain symptoms usually originate in the reproductive organs but can also involve the urinary or intestinal tracts if endometriosis implantation has occurred there. The presentation and physical appearance of endometriosis is extremely variable and can be characterized by a chronic intraperitoneal inflammatory process and adhesions. The only definitive diagnostic technique is laparoscopy. OBJECTIVE: To review current literature on the treatment strategies for endometriosis. METHODS: Review of Pubmed, Cochrane database and Medline for current review articles and studies regarding the current treatment strategies for endometriosis. RESULTS: Initial treatment is surgical or medical. Medical therapy is often used as a first-line therapy and can also be used in conjunction with those patients who undergo surgical therapy for pain. No medical therapy has proven effective for infertility. Medical therapy consists mostly of hormonal suppressive therapy in which the medication causes a downregulation of the hypothalamus-pituitary-ovarian pathway. Non-steroidal anti-inflammatory drugs and oral contraceptives are often used as an initial approach even without a definitive diagnosis. Progestins, such as oral norethindrone and depot medroxyprogesterone, are effective while using them but have a high recurrence rate. The norgestrol intrauterine device is also quite effective at relieving pain associated with endometriosis, especially pain arising during menses as well as from lesions in the rectovaginal tissue. Gonadotropin-releasing hormone agonists induce a pseudomenopausal state and have significant side effects, such as hot flashes and genital atrophy. 'Add-back' therapy with a progestin has been shown to relieve most of these drug related symptoms. Gonadotropin-releasing hormone agonists are also very effective at relieving symptoms of pain during treatment but are also associated with a high recurrence rate. New drug therapies that are under investigation are aromatase inhibitors and immunomodulators. Furthermore, new delivery systems are being investigated that may also improve the patient response.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Hormone Antagonists Animals Contraceptives, Oral Contraceptives, Oral Endometriosis Endometriosis Endometriosis Female Hormone Antagonists Humans Infertility, Female Infertility, Female Infertility, Female Infertility, Female Laparoscopy Laparoscopy Pain Pain Pain

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.

References (97)

Cited by (50)

Source provenance

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