Endometriosis. Overview and future directions.

Several modalities can be employed in managing the patient with endometriosis, and ultimate selection hinges on a number of criteria, including age, extent of disease, severity of symptoms and pain. The current scoring system may underestimate the severity of the disease in some women. For instance, the system does not consider the presence of subtypes of endometriosis in individual patients. Endometriotic implants differ from uterine endometrium in terms of their response to the hormonal milieu and demonstrate a wide range of morphologic development, from poorly to highly differentiated glands. The number of estrogen, progestin and/or androgen receptors in endometriotic lesions may differ markedly from that in normal endometrium. These developments suggest not only problems with current scoring but the possibility of using such innovations as receptor studies to individualize therapy in the future. Danocrine (danazol), an isoxazol derivative of 17-alpha ethinyl-testosterone, when used at appropriate dosages, is an excellent drug for the treatment of endometriosis. Exercise has been demonstrated to markedly reduce the incidence of androgenic side effects that occur with danazol. Gonadotropin releasing hormone agonists also appear to be promising for this indication. Further research is needed with these drugs, especially in the area of combination therapy with danazol.