Endometriosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2], Aravind Kuchkuntla, M.B.B.S[3]

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]

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
Elagolix 150 mg once daily for up to 24 months or 200 mg twice daily for up to 6 months
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
  • 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[13] 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.[14]

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Pall, M. (2001). "Induction of delayed follicular rupture in the human by the selective COX-2 inhibitor rofecoxib: a randomized double-blind study". Human Reproduction. 16 (7): 1323–1328. doi:10.1093/humrep/16.7.1323. ISSN 1460-2350.
  7. Duffy, Diane M.; VandeVoort, Catherine A. (2011). "Maturation and fertilization of nonhuman primate oocytes are compromised by oral administration of a cyclooxygenase-2 inhibitor". Fertility and Sterility. 95 (4): 1256–1260. doi:10.1016/j.fertnstert.2010.12.048. ISSN 0015-0282.
  8. Bedaiwy, Mohamed A.; Allaire, Catherine; Alfaraj, Sukinah (2017). "Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy". Fertility and Sterility. 107 (3): 537–548. doi:10.1016/j.fertnstert.2016.12.024. ISSN 0015-0282.
  9. Allen, Rebecca; Villavicencio, Jennifer (2016). "Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates". Open Access Journal of Contraception: 43. doi:10.2147/OAJC.S85565. ISSN 1179-1527.
  10. 10.0 10.1 "DailyMed - MEDROXYPROGESTERONE ACETATE- medroxyprogesterone acetate injection, suspension".
  11. "DailyMed - AYGESTIN- norethindrone acetate tablet".
  12. "Menopause and Hormone Replacement - Endotext - NCBI Bookshelf".
  13. 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.
  14. 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.