Endometriosis medical therapy

Endometriosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Endometriosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Endometriosis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Endometriosis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Endometriosis medical therapy
CDC on Endometriosis medical therapy
Endometriosis medical therapy in the news
Blogs on Endometriosis medical therapy
Directions to Hospitals Treating Type chapter name here
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

The primary goal of medical therapy is pain management and regression of the endometrial lesions. NSAIDS are useful for pain management. There are many therapeutic options available to reduce the size of endometrial lesions. Gonadotrophin releasing hormone agonists and danazol are widely used. Continuous oral contraceptive pill use is also helpful in patients with mild to moderate endometriosis.

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	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	Hot flushes Vaginal dryness Insomnia Osteopenia Limited use in large ovarian endometromas and severe disease
	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	Breakthrough bleeding Rupture of large endometrioma Weight gain and breast tenderness
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	Elevated liver enzyme levels  Reduction in HDL and TG's Hirsutism
Progestogens only	Medroxyprogesterone acetate	20 to 30 mg orally per day	Feedback inhibition of FSH and LH	Limited use in elderly women Limited use in young women with a desire to conceive soon after therapy Anovulation
	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	Ovarian follicular cyst development Osteopenia
	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.