Endometriosis medical therapy: Difference between revisions

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==Medical Therapy==
==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 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>
*[[Treatment Planning|Treatment]] of [[Patient|patients]] with mild to [[Moderate chronic pain|moderate]] [[pain]] ([[pain]] is not couse of absence) is [[Non-steroidal anti-inflammatory drug|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>
**COX-2 inhibitors (celecoxib, rofecoxib, and valdecoxib) are avoided for patients desire pregnancy.<ref name="Pall2001">{{cite journal|last1=Pall|first1=M.|title=Induction of delayed follicular rupture in the human by the selective COX-2 inhibitor rofecoxib: a randomized double-blind study|journal=Human Reproduction|volume=16|issue=7|year=2001|pages=1323–1328|issn=14602350|doi=10.1093/humrep/16.7.1323}}</ref><ref name="DuffyVandeVoort2011">{{cite journal|last1=Duffy|first1=Diane M.|last2=VandeVoort|first2=Catherine A.|title=Maturation and fertilization of nonhuman primate oocytes are compromised by oral administration of a cyclooxygenase-2 inhibitor|journal=Fertility and Sterility|volume=95|issue=4|year=2011|pages=1256–1260|issn=00150282|doi=10.1016/j.fertnstert.2010.12.048}}</ref>
**[[COX-2 inhibitor|COX-2 inhibitors]] ([[celecoxib]], [[rofecoxib]], and [[valdecoxib]]) are avoided for [[Patient|patients]] [[desire]] [[pregnancy]].<ref name="Pall2001">{{cite journal|last1=Pall|first1=M.|title=Induction of delayed follicular rupture in the human by the selective COX-2 inhibitor rofecoxib: a randomized double-blind study|journal=Human Reproduction|volume=16|issue=7|year=2001|pages=1323–1328|issn=14602350|doi=10.1093/humrep/16.7.1323}}</ref><ref name="DuffyVandeVoort2011">{{cite journal|last1=Duffy|first1=Diane M.|last2=VandeVoort|first2=Catherine A.|title=Maturation and fertilization of nonhuman primate oocytes are compromised by oral administration of a cyclooxygenase-2 inhibitor|journal=Fertility and Sterility|volume=95|issue=4|year=2011|pages=1256–1260|issn=00150282|doi=10.1016/j.fertnstert.2010.12.048}}</ref>
*
*
*Among patients without medical contraindications, the best treatment is combination of estrogen-progestin contraceptives combined and NSAID.<ref name="BedaiwyAllaire2017">{{cite journal|last1=Bedaiwy|first1=Mohamed A.|last2=Allaire|first2=Catherine|last3=Alfaraj|first3=Sukinah|title=Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy|journal=Fertility and Sterility|volume=107|issue=3|year=2017|pages=537–548|issn=00150282|doi=10.1016/j.fertnstert.2016.12.024}}</ref>
*Among [[Patient|patients]] without [[Medicine|medical]] [[contraindications]], the best [[Treatment centre|treatment]] is [[Combination therapy|combination]] of [[estrogen]]-[[progestin]] [[Birth control|contraceptives]] [[Combination therapy|combined]] and [[Non-steroidal anti-inflammatory drug|NSAID]].<ref name="BedaiwyAllaire2017">{{cite journal|last1=Bedaiwy|first1=Mohamed A.|last2=Allaire|first2=Catherine|last3=Alfaraj|first3=Sukinah|title=Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy|journal=Fertility and Sterility|volume=107|issue=3|year=2017|pages=537–548|issn=00150282|doi=10.1016/j.fertnstert.2016.12.024}}</ref>
**Progestin-only contraceptive pills such as norethindrone 0.35 mg (once daily) combined with an NSAID is used among patient who can not use estrogen therapy.<ref name="AllenVillavicencio2016">{{cite journal|last1=Allen|first1=Rebecca|last2=Villavicencio|first2=Jennifer|title=Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates|journal=Open Access Journal of Contraception|year=2016|pages=43|issn=1179-1527|doi=10.2147/OAJC.S85565}}</ref>
**[[Progestin]]-only [[Oral contraceptive|contraceptive pills]] such as [[norethindrone]] 0.35 [[Milligram|mg]] (once daily) [[Combination therapy|combined]] with an [[Non-steroidal anti-inflammatory drug|NSAID]] is used among [[patient]] who can not use [[Hormone replacement therapy|estrogen therapy]].<ref name="AllenVillavicencio2016">{{cite journal|last1=Allen|first1=Rebecca|last2=Villavicencio|first2=Jennifer|title=Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates|journal=Open Access Journal of Contraception|year=2016|pages=43|issn=1179-1527|doi=10.2147/OAJC.S85565}}</ref>
*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]].
**[[Intramuscular injection]] of [[medroxyprogesterone acetate]] ([[Medroxyprogesterone acetate (oral)|MPA]]) 150 [[Milligram|mg]] can helpful every three months.<ref name="urlDailyMed - MEDROXYPROGESTERONE ACETATE- medroxyprogesterone acetate injection, suspension">{{cite web |url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=428481bb-b7cf-4d76-b57d-0d6bfa2b6ac3 |title=DailyMed - MEDROXYPROGESTERONE ACETATE- medroxyprogesterone acetate injection, suspension |format= |work= |accessdate=}}</ref>
**[[Subcutaneous injection]] of [[medroxyprogesterone acetate]] ([[Medroxyprogesterone acetate (oral)|MPA]]) 104 [[Milligram|mg]] can helpful every three months.<ref name="urlDailyMed - MEDROXYPROGESTERONE ACETATE- medroxyprogesterone acetate injection, suspension" />
**[[Norethindrone acetate]] 5 [[Milligram|mg]] can be used by mouth daily (the dose can range from 2.5 mg to 15 mg daily).<ref name="urlDailyMed - AYGESTIN- norethindrone acetate tablet">{{cite web |url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=69f5bc4b-758d-471b-ad8d-17c94f8e0963 |title=DailyMed - AYGESTIN- norethindrone acetate tablet |format= |work= |accessdate=}}</ref>
**[[Adverse effect (medicine)|Side effects]] of [[progestin]] [[Therapy|treatment]] is:<ref name="urlMenopause and Hormone Replacement - Endotext - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK279050/ |title=Menopause and Hormone Replacement - Endotext - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
***Irregular [[uterine]] [[bleeding]]
***Spotting
***[[Amenorrhea]]
***[[Weight gain]]
***[[Mood]] changes
***[[Bone]] loss
***[[Reduction]] in [[High density lipoprotein|high-density lipoprotein]] ([[High density lipoprotein|HDL]]) [[cholesterol]]
***Increases in [[Low density lipoprotein|low-density lipoprotein]] ([[LDL Cholesterol|LDL]])  [[cholesterol]] and [[Triglyceride|triglycerides]]
*
*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]].
{| class="wikitable"
{| class="wikitable"
!Drug Class  
!Drug Class  
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|}
|}
===Pain Management===
===Pain Management===
[[Non-steroidal anti-inflammatory drug|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|oral contraceptive pills]].<ref name="pmid28114727">{{cite journal| author=Brown J, Crawford TJ, Allen C, Hopewell S, Prentice A| title=Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. | journal=Cochrane Database Syst Rev | year= 2017 | volume= 1 | issue=  | pages= CD004753 | pmid=28114727 | doi=10.1002/14651858.CD004753.pub4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28114727  }} </ref>
[[Non-steroidal anti-inflammatory drug|Nonsteroidal anti-inflammatory drugs]] are useful for the control of pain and help to control the amount of [[bleeding]] when used in [[Combination therapy|combination]] with [[Oral contraceptive|oral contraceptive pills]].<ref name="pmid28114727">{{cite journal| author=Brown J, Crawford TJ, Allen C, Hopewell S, Prentice A| title=Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. | journal=Cochrane Database Syst Rev | year= 2017 | volume= 1 | issue=  | pages= CD004753 | pmid=28114727 | doi=10.1002/14651858.CD004753.pub4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28114727  }} </ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 14:15, 17 July 2019

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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.
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