Endometriosis medical therapy
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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
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, and 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.