Medical Management of Endometriosis

Saima Rafique, Alan H Decherney
Clinical obstetrics and gynecology · 2017 · vol. 60(3) , pp. 485–496 · doi:10.1097/grf.0000000000000292 · PMID:28590310 · W2624382807
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Endometriosis, characterized by estrogen-dependent lesions outside the uterus, is treated medically with hormonal and nonhormonal options to control pain and lesion growth, while newer therapies targeting molecular pathways are under development.

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

This paper describes medical management strategies for endometriosis, outlining proposed underlying mechanisms (estrogen-dependent implant growth, inflammatory mediator and prostaglandin overproduction, and progesterone resistance) and how existing drugs target them. It reviews high-level approaches including NSAIDs for pain via COX inhibition, and hormonal therapies such as combined or progestin-only contraceptives, GnRH agonists, aromatase inhibitors, and danazol, plus emerging targets like selective progesterone receptor modulators and anti-angiogenic/immunomodulatory options. A key limitation explicitly noted is that evidence for NSAID effectiveness in controlling endometriosis-related pain is inconclusive and they carry a negative gastrointestinal side-effect profile, and hormonal suppressive therapies require monitoring due to unwanted side effects. This paper is centrally about endometriosis — it focuses on the rationale and therapeutic options for medical management of endometriosis-related pain and lesion suppression.

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Abstract

Endometriosis is a chronic medical condition that affects around 6% to 10% of reproductive age women. Pelvic pain, dysmenorrhea, and infertility are the most common presenting symptoms. The disease is characterized by estrogen-dependent growth of the endometrial glands and stroma outside the endometrial cavity. The diagnosis requires a high degree of suspicion and can be only confirmed on histopathology. Treatment includes medical and surgical options. Both hormonal and nonhormonal medical options are available and are tried at first with a goal to control pain and stop the growth of the endometriotic lesions. Nonsteroidal anti-inflammatory drugs, oral contraceptive pills, gonadotropin-releasing hormone (GnRH) agonists, aromatase inhibitors are some of the commonly used medications. With more research on the molecular and biochemical aspects of endometriosis, newer targets of therapy are being developed like selective progesterone receptor modulators, antiangiogenic factors and immunomodulators. In women who do not respond to medical therapy or have severe symptoms, surgical excision of the endometrial lesions and adhesions is often helpful and offers confirmatory diagnosis by histopathology.

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Condition tags

mesh:D004412mesh:D004715mesh:D017699endometriosisdysmenorrheainfertility

MeSH descriptors

Dysmenorrhea Endometriosis Endometriosis Hormones Pelvic Pain Angiogenesis Inhibitors Angiogenesis Inhibitors Anti-Inflammatory Agents, Non-Steroidal Anti-Inflammatory Agents, Non-Steroidal Combined Modality Therapy Dysmenorrhea Endometriosis Endometriosis Endometrium Endometrium Endometrium Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Hormones

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