Medical Treatment for the Management of Painfull Endometriosis

Background: Endometriosis is an inflammatory estrogen-dependent disease defined by the presence of endometrial glands and stroma at extra uterine sites. The main purpose of endometriosis management is alleviating pain associated to the disease. This can be achieved surgically or medically, although in most women a combination of both treatments is required. Long-term medical treatment is usually needed in most women. Unfortunately, in most cases, pain symptoms recur between 6 months and 12 months once treatment is stopped. Material & Methods: The authors conducted a literature search for English original articles, related to new medical treatments of endometriosis in humans, including articles published in PubMed, Medline, and the Cochrane Library. Keywords included endometriosis matched with medical treatment , Hormonal treatment, Pelvic pain, Dysmenorrhea, from 2010 to present.Result: Combined hormonal contraceptives (OCP) and the levonorgestrel-releasing intra-uterine system (LNG-IUS) are recommended as first-line hormonal therapies for the treatment of painful endometriosis (grade B). Second-line therapy relies on oral desogestrel microprogestative, etonogestrel-releasing implant, GnRH analogs (GnRHa) and dienogest (grade C). It is recommended to use add-back therapy containing estrogen in association with GnRHa (grade B). After endometriosis surgery, hormonal treatment relying on OCP or LNG-IUS is recommended to prevent pain recurrence (grade B). OCP is recommended to reduce the risk of endometrioma recurrence after surgery (grade B) but the prescription of GnRHa is not recommended (grade C). Continuous OCP is recommended in case of dysmenorrhea (grade B). GnRHa is not recommended as first line endometriosis treatment for adolescent girl because of the risk of bone demineralization (grade B). The management of endometriosis-induced chronic pain requires an interdisciplinary evaluation.Conclusion: The effectiveness of medical treatment is well established in the management pelvic pain associated with endometriosis and constitutes an important alternative or complement to surgery.

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PubMed ، Medline ، and the Cochrane Library from 2010 to present