'Waiting for Godot': a commonsense approach to the medical treatment of endometriosis

Paolo Vercellini, Pier Giorgio Crosignani, Crosignani P, PierGiorgio Crosignani, Edgardo Somigliana, Viganò P, Paola Viganò, Maria Pina Frattaruolo, Luigi Fedele
Human Reproduction · 2010 · vol. 26(1) , pp. 3–13 · doi:10.1093/humrep/deq302 · PMID:21071490 · W2117571760
Review OA: bronze CC0 ⤵ 151 in-corpus citations
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Progestins and continuous monophasic oral contraceptives are proposed as the optimal, safe, and cost-effective long-term medical treatment for endometriosis due to their efficacy and ability to prevent recurrence and ovarian cancer.

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Abstract

Conservative surgical treatment for symptomatic endometriosis is frequently associated with only partial relief of pelvic pain or its recurrence. Therefore, medical therapy constitutes an important alternative or complement to surgery. However, no available compound is cytoreductive, and suppression instead of elimination of implants is the only realistic objective of pharmacological intervention. Because this implies prolonged periods of treatments, only medications with a favourable safety/tolerability/efficacy/cost profile should be chosen. In the past few years, innumerable new drugs for endometriosis, which would interfere with several hypothesized pathogenic mechanisms, have been studied and their use foreseen. However, robust evidence of in vivo safety and efficacy is lacking and, at the moment, the principal modality to interfere with endometriosis metabolism is still hormonal manipulation. Regrettably, in spite of consistent demonstration of a major effect on pain even in patients with deeply infiltrating lesions, progestins are underestimated and dismissed in favour of more scientifically fashionable and up-to-the-minute alternatives. Moreover, oral contraceptives (OCs) dramatically reduce the rate of post-operative endometrioma recurrence and should now be considered an essential part of long-term therapeutic strategies in order to limit further damage to future fertility. Finally, women who have used OC for prolonged periods will be protected from an increased risk of endometriosis-associated ovarian cancer. To avoid the several subtle modalities for distorting facts and orientating opinions in favour of specific compounds, progestins and monophasic OC used continuously are here proposed as the reference comparator in all future randomized controlled trials on medical treatment for endometriosis.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Contraceptives, Oral Endometriosis Contraceptives, Oral Contraceptives, Oral Contraceptives, Oral Drug-Related Side Effects and Adverse Reactions Drug-Related Side Effects and Adverse Reactions Drugs, Investigational Drugs, Investigational Drugs, Investigational Drugs, Investigational Endometriosis Endometriosis Endometriosis Endometriosis Female Female Humans Humans Randomized Controlled Trials as Topic

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 (50)

Source provenance

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