Medical management of endometriosis

Alexis L Newmark, Newmark AL, A Newmark, D. Luciano, Danielle E Luciano, Luciano DE, Ulrich A, Amanda Ulrich, Luciano AA, Anthony A. Luciano
Minerva obstetrics and gynecology · 2021 · vol. 73(5) , pp. 572–587 · doi:10.23736/s2724-606x.21.04776-x · PMID:34264045 · W3179317957
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This review discusses the pathogenesis and current medical management of endometriosis, a chronic inflammatory disease, highlighting suppressive therapies, their limitations, and future treatment directions.

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Abstract

Endometriosis is a benign gynecologic disorder that is defined as functional endometrial tissue outside of the uterine cavity. It is an estrogen-dependent, inflammatory disease that leads to symptoms of pelvic pain, dysmenorrhea, dyspareunia, and infertility, occurring in 6-10% of reproductive aged women. The severity of the disease ranges from asymptomatic to debilitating symptoms that have a major impact on women's lives. It is a chronic, recurrent disease, frequently requiring long term management until menopause and beyond. It is considered a chronic disorder that is managed with surgery, medical treatment, and oftentimes, both. Current medical therapy for endometriosis is considered suppressive of the disease, rather than curative. Fortunately, many patients do experience improvement and control of their symptoms with medical therapy. However, long-term efficacy of the medical treatments is often limited by side effects and the cost of therapy, and symptoms do tend to recur after discontinuation of these medications. This review summarizes our understanding of the pathogenesis of endometriosis and provides more in-depth discussion of specific medical management options used to treat endometriosis, including mechanism of action and side effects. It also provides recommendations on strategy with a forward look to novel endometriosis treatments in the future. The authors emphasized that endometriosis is a chronic disorder requiring long term medical therapy. Early diagnosis of endometriosis is key in preventing severe, debilitating symptoms and progression of disease. By utilizing our current knowledge of the pathophysiology of endometriosis and by correctly implementing currently available medical and surgical therapies we can significantly reduce the physical, psychosocial and financial burden of this chronic, recurrent and indolent disease. Current available medications are suppressive therapies, but the authors are looking forward to future therapies that can effectively cure or at least control endometriosis with minimal side effects. Future research should continue to look for the genetic trigger for endometriosis which can lead us to its underlying pathogenesis and eventually a cure or prevention.

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Condition tags

dysmenorrheadyspareuniaendometriosischronic_pelvic_paininfertility

MeSH descriptors

Dyspareunia Dyspareunia Endometriosis Endometriosis Endometriosis Adult Adult Dysmenorrhea Dysmenorrhea Endometrium Endometrium Female Female Humans Humans Pelvic Pain Pelvic Pain Pelvic Pain

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 (100)

Cited by (12)

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License: CC0 · commercial use OK