Endometriosis medical therapy: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 5: | Line 5: | ||
==Overview== | ==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. | The primary goal of medical therapy is pain management and regression of the [[Endometrium|endometrial lesions]]. [[NSAIDS]] are useful for pain management. There are many therapeutic options available to reduce the size of endometrial lesions. [[Gonadotropin-releasing hormone agonist|Gonadotrophin releasing hormone agonists]] and [[danazol]] are widely used. Continuous [[Combined oral contraceptive pill|oral contraceptive pill]] use is also helpful in patients with mild to moderate [[endometriosis]]. | ||
==Medical Therapy== | ==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.<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> | 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 a child|conceive]]. The primary goal of medical therapy is 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 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. <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]] 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 [[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> | ||
*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]]. | ||
{| class="wikitable" | {| class="wikitable" | ||
!Drug Class | !Drug Class | ||
| Line 18: | Line 18: | ||
!Limitations of therapy | !Limitations of therapy | ||
|- | |- | ||
| rowspan="3" |Gonadotrophin releasing hormone agonists | | rowspan="3" |[[Gonadotropin-releasing hormone agonist|Gonadotrophin releasing hormone agonists]] | ||
|Leuprolide acetate | |[[Leuprolide]] acetate | ||
|3.75 mg intramuscularly once per month OR | |3.75 mg [[Intramuscular injection|intramuscularly]] once per month OR | ||
11.25-mg depot injection every 3 months | 11.25-mg depot injection every 3 months | ||
| rowspan="3" | | | rowspan="3" | | ||
*Down-regulation of the pituitary resulting in decreased production of FSH and LH | *Down-regulation of the [[Pituitary gland|pituitary]] resulting in decreased production of [[FSH]] and [[Luteinizing hormone|LH]] | ||
*Results in a reduction in serum estrogen, testosterone, and androstenedione. | *Results in a reduction in serum [[estrogen]], [[testosterone]], and [[androstenedione]]. | ||
* | *[[Amenorrhea]] is induced in 6 to 8 weeks of therapy | ||
| rowspan="3" | | | rowspan="3" | | ||
*Hot flushes | *[[Hot flushes]] | ||
*Vaginal dryness | *[[Vaginal dryness]] | ||
*Insomnia | *[[Insomnia]] | ||
*Osteopenia | *[[Osteopenia]] | ||
*Limited use in large ovarian endometromas and severe disease | *Limited use in large ovarian endometromas and severe disease | ||
|- | |- | ||
|Nafarelin acetate | |[[Nafarelin]] acetate | ||
|Nasal spray dose of one spray 200 μg twice a day | |Nasal spray dose of one spray 200 μg twice a day | ||
|- | |- | ||
|Goserelin acetate | |[[Goserelin acetate|Goserelin]] acetate | ||
|3.6 mg every 28 days in a biodegradable subcutaneous implant | |3.6 mg every 28 days in a biodegradable subcutaneous implant | ||
|- | |- | ||
|Oral contraceptive pills | |[[Oral contraceptive|Oral contraceptive pills]] | ||
|Low dose estrogen and high dose progesterone pills | |Low dose [[estrogen]] and high dose [[progesterone]] pills | ||
|Continuous therapy for a duration of 6 to 12 months | |Continuous therapy for a duration of 6 to 12 months | ||
|Feedback inhibition of FSH and LH | |Feedback inhibition of [[FSH]] and [[LH]] | ||
| | | | ||
*Breakthrough bleeding | *Breakthrough bleeding | ||
*Rupture of large endometrioma | *Rupture of large endometrioma | ||
*Weight gain and breast tenderness | *[[Weight gain]] and breast tenderness | ||
|- | |- | ||
|Synthetic steroid | |Synthetic [[steroid]] | ||
| | |[[Danazol]] | ||
|200mg to 400mg orally per day for 6 to 9 months | |200mg to 400mg orally per day for 6 to 9 months | ||
|Produces a hypoestrogenic and hyperandrogenic effect and induces atrophic changes in the endometrium | |Produces a hypoestrogenic and hyperandrogenic effect and induces atrophic changes in the [[endometrium]] | ||
| | | | ||
*Elevated liver enzyme levels | *Elevated [[liver enzyme]] levels | ||
*Reduction in HDL and TG's | *Reduction in [[HDL Cholesterol|HDL]] and [[Triglyceride|TG's]] | ||
*Hirsutism | *[[Hirsutism]] | ||
|- | |- | ||
| rowspan="2" |Progestogens only | | rowspan="2" |[[Progestogens]] only | ||
|Medroxyprogesterone acetate | |Medroxyprogesterone acetate | ||
|20 to 30 mg orally per day | |20 to 30 mg orally per day | ||
| rowspan="2" |Feedback inhibition of FSH and LH | | rowspan="2" |Feedback inhibition of [[FSH]] and [[Luteinizing hormone|LH]] | ||
| rowspan="2" | | | rowspan="2" | | ||
*Limited use in elderly women | *Limited use in elderly women | ||
*Limited use in young women with a desire to conceive soon after therapy | *Limited use in young women with a desire to conceive soon after therapy | ||
*Anovulation | *[[Anovulation]] | ||
|- | |- | ||
|Depo-medroxyprogesterone acetate | |[[Medroxyprogesterone acetate (injection)|Depo-medroxyprogesterone acetate]] | ||
|150 mg intramuscularly every 3 months | |150 mg intramuscularly every 3 months | ||
|- | |- | ||
| rowspan="2" |Aromatase inhibitors<ref name="pmid27095958">{{cite journal| author=Słopień R, Męczekalski B| title=Aromatase inhibitors in the treatment of endometriosis. | journal=Prz Menopauzalny | year= 2016 | volume= 15 | issue= 1 | pages= 43-7 | pmid=27095958 | doi=10.5114/pm.2016.58773 | pmc=4828508 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27095958 }} </ref> | | rowspan="2" |[[Aromatase inhibitor|Aromatase inhibitors]]<ref name="pmid27095958">{{cite journal| author=Słopień R, Męczekalski B| title=Aromatase inhibitors in the treatment of endometriosis. | journal=Prz Menopauzalny | year= 2016 | volume= 15 | issue= 1 | pages= 43-7 | pmid=27095958 | doi=10.5114/pm.2016.58773 | pmc=4828508 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27095958 }} </ref> | ||
|Anastrozole | |[[Anastrozole]] | ||
|1 mg once daily | |1 mg once daily | ||
| rowspan="2" |Inhibition of aromatase expressed in the endometriomas resulting in decreased estrogen levels | | rowspan="2" |Inhibition of [[aromatase]] expressed in the endometriomas resulting in decreased [[estrogen]] levels | ||
| rowspan="2" | | | rowspan="2" | | ||
*Ovarian follicular cyst development | *[[Ovarian cyst|Ovarian follicular cyst]] development | ||
*Osteopenia | *[[Osteopenia]] | ||
|- | |- | ||
|Letrozole | |[[Letrozole]] | ||
|2.5 mg once daily | |2.5 mg once daily | ||
|} | |} | ||
===Pain Management=== | ===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.<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 in controlling 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> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 15:29, 20 June 2017
|
Endometriosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Endometriosis medical therapy On the Web |
|
American Roentgen Ray Society Images of Endometriosis medical therapy |
|
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.[1][2][3]
- 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. [4]
- 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 |
|
|
| 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[5] | 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 in controlling the amount of bleeding when used in combination with oral contraceptive pills.[6]
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.
- ↑ 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.