Endometriosis medical therapy: Difference between revisions
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| Line 20: | Line 20: | ||
|3.75 mg intramuscularly once per month OR | |3.75 mg intramuscularly once per month OR | ||
11.25-mg depot injection every 3 months | 11.25-mg depot injection every 3 months | ||
| rowspan="3" |Down-regulation of the pituitary resulting in decreased production of FSH and LH | | rowspan="3" | | ||
Results in a reduction in serum estrogen, testosterone, and androstenedione. | *Down-regulation of the pituitary resulting in decreased production of FSH and LH | ||
*Results in a reduction in serum estrogen, testosterone, and androstenedione. | |||
Amennorhea is induced in 6 to 8 weeks of therapy | *Amennorhea is induced in 6 to 8 weeks of therapy | ||
| rowspan="3" |Hot flushes | | rowspan="3" | | ||
Osteopenia | *Hot flushes | ||
*Vaginal dryness | |||
Limited use in large ovarian endometromas and severe disease | *Insomnia | ||
*Osteopenia | |||
*Limited use in large ovarian endometromas and severe disease | |||
|- | |- | ||
|Nafarelin acetate | |Nafarelin acetate | ||
| Line 39: | Line 41: | ||
|Continuous therapy for a duration of 6 to 12 months | |Continuous therapy for a duration of 6 to 12 months | ||
|Feedback inhibition of FSH and LH | |Feedback inhibition of FSH and LH | ||
|Breakthrough bleeding | | | ||
Rupture of large endometrioma | *Breakthrough bleeding | ||
*Rupture of large endometrioma | |||
Weight gain and breast tenderness | *Weight gain and breast tenderness | ||
|- | |- | ||
|Synthetic steroid | |Synthetic steroid | ||
| Line 48: | Line 50: | ||
|200mg to 400mg orally per day for 6 to 9 months | |200mg to 400mg orally per day for 6 to 9 months | ||
|Produces a hypoestrogenic and hyperandrogenic effect and induces atrophic changes in the endometrium | |Produces a hypoestrogenic and hyperandrogenic effect and induces atrophic changes in the endometrium | ||
|Elevated liver enzyme levels | | | ||
Reduction in HDL and TG's | *Elevated liver enzyme levels | ||
*Reduction in HDL and TG's | |||
Hirsutism | *Hirsutism | ||
|- | |- | ||
| rowspan="2" |Progestogens only | | rowspan="2" |Progestogens only | ||
| Line 57: | Line 59: | ||
|20 to 30 mg orally per day | |20 to 30 mg orally per day | ||
| rowspan="2" |Feedback inhibition of FSH and LH | | rowspan="2" |Feedback inhibition of FSH and LH | ||
| rowspan="2" |Limited use in elderly women | | rowspan="2" | | ||
Limited use in young women with a desire to conceive soon after therapy | *Limited use in elderly women | ||
*Limited use in young women with a desire to conceive soon after therapy | |||
Anovulation | *Anovulation | ||
|- | |- | ||
|Depo-medroxyprogesterone acetate | |Depo-medroxyprogesterone acetate | ||
| Line 69: | Line 71: | ||
|1 mg once daily | |1 mg once daily | ||
| rowspan="2" |Inhibition of aromatase expressed in the endometriomas resulting in decreased estrogen levels | | rowspan="2" |Inhibition of aromatase expressed in the endometriomas resulting in decreased estrogen levels | ||
| rowspan="2" |Ovarian follicular cyst development | | rowspan="2" | | ||
Osteopenia | *Ovarian follicular cyst development | ||
*Osteopenia | |||
|- | |- | ||
|Letrozole | |Letrozole | ||
Revision as of 19:50, 15 June 2017
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Endometriosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Endometriosis medical therapy On the Web |
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American Roentgen Ray Society Images of Endometriosis medical therapy |
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Risk calculators and risk factors for Endometriosis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Medical Therapy
Treatment of endometriosis is a combination of medical and surgical therapy, based on the extent of the disease, based on the age of the patient and the desire to conceive. The primary goal of medical therapy is symptomatic improvement of pain and regression of the endometrial lesions.
- Endometriosis is due to increased levels of estrogen which is a result of excess production in the body or due to exogenous estrogen intake. Therefore, the primary goal of medical therapy is to shut off the estrogen supply which is essential for the growth of the endometrial lesions.
- There are several therapeutic agents available to decrease estrogen production. The following table is a description of different therapeutic agents available for the treatment of endometriosis.
| Drug Class | Drugs | Duration of therapy | Mechanism of Action | Limitations of therapy |
|---|---|---|---|---|
| Gonadotrophin releasing hormone Agonists | Leuprolide acetate | 3.75 mg intramuscularly once per month OR
11.25-mg depot injection every 3 months |
|
|
| Nafarelin acetate | Nasal spray dose of one spray 200 μg twice a day | |||
| Goserelin acetate | 3.6 mg every 28 days in a biodegradable subcutaneous implant. | |||
| Oral contraceptive pills | Low dose estrogen and high dose progesterone pills | Continuous therapy for a duration of 6 to 12 months | Feedback inhibition of FSH and LH |
|
| Synthetic steroid | Danazol | 200mg to 400mg orally per day for 6 to 9 months | Produces a hypoestrogenic and hyperandrogenic effect and induces atrophic changes in the endometrium |
|
| Progestogens only | Medroxyprogesterone acetate | 20 to 30 mg orally per day | Feedback inhibition of FSH and LH |
|
| Depo-medroxyprogesterone acetate | 150 mg intramuscularly every 3 months | |||
| Aromatase inhibitors | Anastrozole | 1 mg once daily | Inhibition of aromatase expressed in the endometriomas resulting in decreased estrogen levels |
|
| Letrozole | 2.5 mg once daily |
Pain Management
Nonsteroidal anti-inflammatory drugs are useful for the control of pain and help in controlling the amount of bleeding when used in combination with oral contraceptive pills.