Treatment of pain associated with deep endometriosis: alternatives and evidence

Simone Ferrero, Alessandri F, Franco Alessandri, Annalisa Racca, Racca A, Umberto Leone Roberti Maggiore
Fertility and sterility · 2015 · vol. 104(4) , pp. 771–792 · doi:10.1016/j.fertnstert.2015.08.031 · PMID:26363387 · W2153676064
review OA: closed CC0 ⤵ 91 in-corpus citations
View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This paper reviews treatment options and evidence for pain management in patients with deep endometriosis.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

Pain is the most evident clinical manifestation of deep infiltrating endometriosis (DIE). Several hormonal and immunologic mechanisms are markedly altered in DIE compared with superficial peritoneal and ovarian endometriosis, and may explain its most aggressive behavior and the presence of severe pain symptoms. Hormonal therapies, such as combined hormonal contraceptives and progestogens, should be regarded as first-line treatment, as they are efficacious, safe, and well tolerated. Gonadotropin-releasing hormone agonists may be used in patients with symptoms persisting after the administration of first-line therapies. Scanty literature is available for danazol treatment in patients with DIE and, however, it has become less popular due to the high rates of androgenic adverse events (AEs). The partial relief of pain that often is achieved with available therapies and its recurrence after the suspension of the treatment have brought to the development of new therapies (such as aromatase inhibitors, oral GnRH antagonists) that are currently under investigation. Surgical excision of DIE should be considered in patients with pain symptoms persisting after first-line hormonal therapies. The benefits of surgery in terms of pain improvement should be always balanced with the risk of intraoperative complications and for this reason surgical cases should be referred to tertiary centers for the treatment of DIE. A multidisciplinary approach is mandatory in patients with DIE involving the bowel and/or the urinary tract.

My notes (saved in your browser only)

Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Pain Management Pelvic Pain Pelvic Pain Analgesics Analgesics Endometriosis Endometriosis Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Hormone Antagonists Hormone Antagonists Humans Pain Management Pelvic Pain Progestins Progestins Severity of Illness Index

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 (100)

Cited by (50)

Source provenance

europepmc
last seen: 2026-08-08T06:08:32.324769+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-05-13T22:17:39.907309+00:00
License: CC0 · commercial use OK