Endometriosis medical therapy: Difference between revisions
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The treatment of [[endometriosis]] is a combination of medical and surgical therapy based on the extent of the disease, the age of the patient, and the desire of the patient to [[Conceive a child|conceive]]. The primary goal of medical therapy is the symptomatic improvement of pain and regression of the [[Endometrium|endometrial]] [[lesions]].<ref name="pmid28139238">{{cite journal| author=Bedaiwy MA, Alfaraj S, Yong P, Casper R| title=New developments in the medical treatment of endometriosis. | journal=Fertil Steril | year= 2017 | volume= 107 | issue= 3 | pages= 555-565 | pmid=28139238 | doi=10.1016/j.fertnstert.2016.12.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28139238 }} </ref><ref name="pmid27615386">{{cite journal| author=Benagiano G, Guo SW, Bianchi P, Puttemans P, Gordts S, Petraglia F et al.| title=Pharmacologic treatment of the ovarian endometrioma. | journal=Expert Opin Pharmacother | year= 2016 | volume= 17 | issue= 15 | pages= 2019-31 | pmid=27615386 | doi=10.1080/14656566.2016.1229305 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27615386 }} </ref><ref name="pmid23356536">{{cite journal| author=Streuli I, de Ziegler D, Santulli P, Marcellin L, Borghese B, Batteux F et al.| title=An update on the pharmacological management of endometriosis. | journal=Expert Opin Pharmacother | year= 2013 | volume= 14 | issue= 3 | pages= 291-305 | pmid=23356536 | doi=10.1517/14656566.2013.767334 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23356536 }} </ref> | The treatment of [[endometriosis]] is a combination of medical and surgical therapy based on the extent of the disease, the age of the patient, and the desire of the patient to [[Conceive a child|conceive]]. The primary goal of medical therapy is the symptomatic improvement of pain and regression of the [[Endometrium|endometrial]] [[lesions]].<ref name="pmid28139238">{{cite journal| author=Bedaiwy MA, Alfaraj S, Yong P, Casper R| title=New developments in the medical treatment of endometriosis. | journal=Fertil Steril | year= 2017 | volume= 107 | issue= 3 | pages= 555-565 | pmid=28139238 | doi=10.1016/j.fertnstert.2016.12.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28139238 }} </ref><ref name="pmid27615386">{{cite journal| author=Benagiano G, Guo SW, Bianchi P, Puttemans P, Gordts S, Petraglia F et al.| title=Pharmacologic treatment of the ovarian endometrioma. | journal=Expert Opin Pharmacother | year= 2016 | volume= 17 | issue= 15 | pages= 2019-31 | pmid=27615386 | doi=10.1080/14656566.2016.1229305 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27615386 }} </ref><ref name="pmid23356536">{{cite journal| author=Streuli I, de Ziegler D, Santulli P, Marcellin L, Borghese B, Batteux F et al.| title=An update on the pharmacological management of endometriosis. | journal=Expert Opin Pharmacother | year= 2013 | volume= 14 | issue= 3 | pages= 291-305 | pmid=23356536 | doi=10.1517/14656566.2013.767334 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23356536 }} </ref> | ||
*[[Endometriosis]] occurs due to increased levels of [[estrogen]]. This may be a result of excess production in the body or [[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 [[Endometrium|endometrial]] [[lesions]].<ref name="pmid23427639">{{cite journal| author=Mateo Sánez HA, Mateo Sánez E, Hernández AL, Salazar Ricarte EL| title=[Treatment of patients with endometriosis and infertility]. | journal=Ginecol Obstet Mex | year= 2012 | volume= 80 | issue= 11 | pages= 705-11 | pmid=23427639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23427639 }} </ref> | *[[Endometriosis]] occurs due to increased levels of [[estrogen]]. This may be a result of excess production in the body or [[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 [[Endometrium|endometrial]] [[lesions]].<ref name="pmid23427639">{{cite journal| author=Mateo Sánez HA, Mateo Sánez E, Hernández AL, Salazar Ricarte EL| title=[Treatment of patients with endometriosis and infertility]. | journal=Ginecol Obstet Mex | year= 2012 | volume= 80 | issue= 11 | pages= 705-11 | pmid=23427639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23427639 }} </ref> | ||
*Treatment of patients with mild to moderate pain (pain is not couse of absence) is nonsteroidal anti-inflammatory drugs (NSAIDs).<ref name="BrownCrawford2017">{{cite journal|last1=Brown|first1=Julie|last2=Crawford|first2=Tineke J|last3=Allen|first3=Claire|last4=Hopewell|first4=Sally|last5=Prentice|first5=Andrew|title=Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis|journal=Cochrane Database of Systematic Reviews|year=2017|issn=14651858|doi=10.1002/14651858.CD004753.pub4}}</ref> | |||
*For women with mild to moderate pain (eg, pain symptoms that do not cause regular absence from school or work) and no ultrasound evidence of an endometrioma, we prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) | |||
*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]]. | *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]]. | ||
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Revision as of 01:04, 8 July 2019
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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 mainstay of therapy for endometriosis is pain management and regression of 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
The treatment of endometriosis is a combination of medical and surgical therapy based on the extent of the disease, the age of the patient, and the desire of the patient to conceive. The primary goal of medical therapy is the symptomatic improvement of pain and regression of the endometrial lesions.[1][2][3]
- Endometriosis occurs due to increased levels of estrogen. This may be a result of excess production in the body or 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.[4]
- Treatment of patients with mild to moderate pain (pain is not couse of absence) is nonsteroidal anti-inflammatory drugs (NSAIDs).[5]
- For women with mild to moderate pain (eg, pain symptoms that do not cause regular absence from school or work) and no ultrasound evidence of an endometrioma, we prescribe nonsteroidal anti-inflammatory drugs (NSAIDs)
- 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 | Side effects 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[6] | 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 to control the amount of bleeding when used in combination with oral contraceptive pills.[7]
References
- ↑ Bedaiwy MA, Alfaraj S, Yong P, Casper R (2017). "New developments in the medical treatment of endometriosis". Fertil Steril. 107 (3): 555–565. doi:10.1016/j.fertnstert.2016.12.025. PMID 28139238.
- ↑ Benagiano G, Guo SW, Bianchi P, Puttemans P, Gordts S, Petraglia F; et al. (2016). "Pharmacologic treatment of the ovarian endometrioma". Expert Opin Pharmacother. 17 (15): 2019–31. doi:10.1080/14656566.2016.1229305. PMID 27615386.
- ↑ Streuli I, de Ziegler D, Santulli P, Marcellin L, Borghese B, Batteux F; et al. (2013). "An update on the pharmacological management of endometriosis". Expert Opin Pharmacother. 14 (3): 291–305. doi:10.1517/14656566.2013.767334. PMID 23356536.
- ↑ Mateo Sánez HA, Mateo Sánez E, Hernández AL, Salazar Ricarte EL (2012). "[Treatment of patients with endometriosis and infertility]". Ginecol Obstet Mex. 80 (11): 705–11. PMID 23427639.
- ↑ Brown, Julie; Crawford, Tineke J; Allen, Claire; Hopewell, Sally; Prentice, Andrew (2017). "Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD004753.pub4. ISSN 1465-1858.
- ↑ Słopień R, Męczekalski B (2016). "Aromatase inhibitors in the treatment of endometriosis". Prz Menopauzalny. 15 (1): 43–7. doi:10.5114/pm.2016.58773. PMC 4828508. PMID 27095958.
- ↑ Brown J, Crawford TJ, Allen C, Hopewell S, Prentice A (2017). "Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis". Cochrane Database Syst Rev. 1: CD004753. doi:10.1002/14651858.CD004753.pub4. PMID 28114727.