Medical treatment of endometriosis in infertile patients

B V Lewis, Lewis BV
Irish journal of medical science · 1983 · vol. 152(S2) , pp. 22–25 · doi:10.1007/bf02945277 · PMID:6885321 · W2025046958
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Medical treatment of endometriosis, including analgesia, estrogen/progestogen, or progestogen therapy, can achieve 60-70% pregnancy success rates in infertile patients with minimal to moderate disease.

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This paper reviews medical management of endometriosis in infertile patients, describing use of simple analgesia, combined estrogen/progestogen therapy, progestogen therapy alone, and danazol (about 400 mg daily for at least six months). It reports pregnancy success rates around 60–70% overall, dropping to about 35–56% when associated factors such as oligospermia or pelvic inflammatory disease are present, with higher pregnancy rates in moderate than extensive disease. Recurrence after stopping therapy is described as 17% at one year up to 50% after nine years, and drug side effects are noted as dose-related and include androgenic symptoms, pituitary-gonadal inhibition effects, systemic effects, and blood chemistry disorders. This paper is centrally about endometriosis in infertile patients, focusing on the outcomes and adverse effects of hormonal and danazol-based medical treatments.

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Summary MEDICAL treatment of endometriosis is suitable as primary therapy in young patients with minimal disease confirmed by laparoscopy. Medical treatment consists of simple analgesia, treatment with combined oestrogen/progestogen preparations, or progestogen therapy alone. Danazol therapy is now widely used in a dose of about 400 mgs daily for a minimum of six months. The success rate in terms of pregnancy is about 60–70%, but when other associated factors are included such as oligospermia or pelvic inflammatory disease, the success rate falls to between 35–56%. The pregnancy rate with medical treatment is more successful with moderate disease than extensive disease, and the recurrence rate after cessation of therapy varies from 17% after one year to 50% after nine years. The side-effects of drug therapy are dose related and include symptoms due to the androgenic effects of the drug, symptoms due to pituitary-gonadal inhibition, generalised systemic effects and disorders in blood chemistry. Similar content being viewed by others References Andrews, W.C., and Larsen, G.D., 1974. Endometriosis: Treatment with hormonal pseudopregnancy and/or operation.Am. J. Obstet. Gynaec. 118,643. Audebert, A.J.M., Larrue-Charlus, S., and Emperaire, J.C., 1979. Endometriosis and infertility.Postgraduate Medical Journal,55, suppl. 5, 5. Barbieri, R.L., Ryan, K.J., 1981. Danazol: Endocrine pharmacology and therapeutic applications.Am. J. Obstet. Gynaec. 141:4, 453. Biberoglu, K.O., Behrman, S.J., 1981. Dosage aspects of Danazol therapy in endometriosis: Short-term and long-term effectiveness.Am. J. Obstet. Gynaec. 139:6, 645. Brosens, I.A., Konincky, P.R., and Corvelyn, P.A., 1978. A study of plasma progesterone, oestradiol 17B, prolactin and LH levels and of the luteal phase appearance of the ovaries in patients with endometriosis and infertility.Brit. J. Obstet. Gynaecol. 85:246. Daniell, J.F., Christianson, C., 1981. Combinedlaparoscopic surgery and Danazol therapy for pelvic endometriosis.Fertil. & Steril. 35:5, 521. Dmowski, W. P., Cohen, M.R., 1978. Antigonadotropin (Danazol) inthetreatment of endometriosis.Am. J. Obstet, Gynaec. 130:1. Duck, S.C., Katayama, K.P., 1981. Danazolmay cause female pseudohermaphroditism.Fertil. & Steril,35:230. Fraser, J.S., 1979. Danazol — a steroid with a unique combination of actions.Scof. Med. J. 24:147 Greenblatt, R.B., Tzingounis, V., 1979. Danazol treatment of endometriosis: Long-term follow-up.Fertil. & Steril.32:5, 518. Jenkin, G., 1980. The mechanism of action of Danazol, a noval steroid derivative.Aust. N. Z. J. Obstet. Gynaec. 20:113. Kistner, R.W., 1962. Infertility and endometriosis: a plan of therapy.Fertil. & Steril. 13:237. Mettler, L., and Semm, K., 1979. Clinical and biochemical experiences with Danazol in the treatment of endometriosis in cases with female infertility.Postgraduate Medical JOurnal.55: Suppl. 5, 5. Moore, E.E., etal, 1981. Management of pelvic endometriosis with low-dose Danazol.Fertil. & Steril. 36:1,15. Noble, A.D., Letchworth, A.T., 1980. Treatment of endometriosis: A study of medical management.Brit. J. Obstet. & Gynaec. 87:726. Potts, G.O., Schane, H.P., Edelson., 1980. Pharmacology and pharmacokinetics of Danazol.Drugs 19:321. Reiva, H.L., Wilson, J.H. and Kawasaki, D.M., 1961. Effect of Norethynodrel on endometriosis.Am. J. Obstet. Gynaec. 82:109. Vanzyl, J.A., Mullerms, and Van Niekerk, W.A., 1980. Danazol in the treatment of endometriosis.Externa. S. Afr. Med. J. 58:591. Wheeler, J.M., Malinak, R., 1981. Postoperative Danazol therapy in infertility patients with severe endometriosis.Fertil. & Steril. 36:3&4, 460. Author information Authors and Affiliations Rights and permissions About this article Cite this article Lewis, B.V. Medical treatment of endometriosis in infertile patients. Ir J Med Sci 152 (Suppl 2), 22–25 (1983). https://doi.org/10.1007/BF02945277 Issue date: DOI: https://doi.org/10.1007/BF02945277

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endometriosis

MeSH descriptors

Danazol Endometriosis Gonadal Steroid Hormones Infertility, Female Pelvic Neoplasms Pregnadienes Danazol Danazol Endometriosis Female Genital Neoplasms, Female Genital Neoplasms, Female Gonadal Steroid Hormones Humans Infertility, Female Pelvic Neoplasms Pregnadienes Pregnancy

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