Medical management of endometriosis: a systematic review
Systematic review / meta-analysis
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⤵ 25 in-corpus citations
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This systematic review analyzed prospective studies of medical endometriosis treatments, finding GnRH agonists most effective but expensive, progestins cost-effective with good profiles, and oral contraceptives only effective during treatment.
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Abstract
Endometriosis is an important clinical problem in routine practice. Besides the problems of dysmenorrhea, dyspareunia and chronic abdominal pain, women with endometriosis are often infertile. We performed a systematic literature review on two issues: firstly, we clarified which medical treatment options have been investigated in prospective, randomized studies. Secondly, potential future treatments, still being preclinically investigated, were examined. A meta-analysis was not possible as the studies varied too much in their protocols and inclusion and exclusion criteria, as well as in the drugs and doses administered. Gonadotropin-releasing hormone (GnRH) agonists, progestins and oral contraceptives all appear to offer certain advantages for endometriosis patients. GnRH agonists appear to be the most effective but they are expensive and long-term treatment is not possible because of loss of bone mineral density. Estrogen add-back may offer some benefit for the clinical complaints of patients, but it may reduce the efficacy of GnRH agonists. Progestins have the best clinical profile and a good cost-effectiveness balance; however, most studies found that they were not as effective as GnRH agonists. Oral contraceptives are only effective during treatment and have a high relapse rate after therapy is completed. Future options may include the use of GnRH agonists, selective estrogen receptor modulators (SERMs) and anti-estrogens, as well as immunomodulators.
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Cited by (25)
- Advances in the diagnosis and management of endometriosis: A comprehensive review 2025
- Advances in the Diagnosis and Management of Endometriosis: A Comprehensive Review 2024
- Selective oestrogen receptor modulators (SERMs) for endometriosis 2021
- The health-related quality of life of patients with a benign gynecological condition: a 2-year follow-up 2021
- Irritable Bowel Syndrome-Like Disorders in Endometriosis: Prevalence of Nickel Sensitivity and Effects of a Low-Nickel Diet. An Open-Label Pilot Study 2020
- Medical management of endometriosis: what the radiologist needs to know 2020
- Surgery versus pharmacological treatment for endometriosis 2014
- Selective estrogen receptor modulators (SERMs) for endometriosis 2014
- Effectiveness of complex therapy for endometrioid ovarian cysts depending on the presence or absence of undifferentiated dysplasia of connective tissue 2014
- Analysis of the levonorgestrel-releasing intrauterine system in women with endometriosis 2013
- Detailed analysis of a randomized, multicenter, comparative trial of dienogest versus leuprolide acetate in endometriosis 2012
- Medical Therapies: Progestins 2011
- Administration of betaHCG leads to dose-dependent changes of gene expression signature of endometriotic stromal cells 2010
- The place of dydrogesterone in the treatment of endometriosis and adenomyosis 2009
- Efficacy of vaginal danazol treatment in women with recurrent deeply infiltrating endometriosis 2007
- Effect of highly purified human chorionic gonadotropin preparations on the gene expression signature of stromal cells derived from endometriotic lesions: potential mechanisms for the therapeutic effect of human chorionic gonadotropin in vivo 2007
- Sterilitätstherapie bei Endometriose 2007
- Economic burden of endometriosis 2006
- Oral contraceptives for endometriosis-associated pain 2006
- Tratamiento médico de la endometriosis (excluyendo la adenomiosis) 2006
- A randomized, parallel, comparative study of the efficacy and safety of nafarelin versus danazol in the treatment of endometriosis in Taiwan 2005
- Traitement médicamenteux de l'endométriose (adénomyose exclue) 2005
- Traitement médicamenteux de l'endométriose (adénomyose exclue) 2005
- Sistema intra-uterino liberador de levonorgestrel no controle da dor pelvica em mulheres com endometriose 2005
- Bufalin induces apoptosis and the G0/G1 cell cycle arrest of endometriotic stromal cells: a promising agent for the treatment of endometriosis 2005
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- europepmc
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- openalex
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- pubmed
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