[The therapy of endometriosis. New prospects].
Surgery is still the first line of therapy for endometriosis. At present, medical therapy is mostly indicated for treatment and prevention of recurrences. Current pharmacological regimens induce a hypoestrogenic state; this effect tends, on one hand, to inhibit the growth of endometriotic implants while, on the other hand, it significantly interferes with the integrity of the hypothalamus-pituitary-ovarian axis. The aim of this study is to review current knowledge on the new experimental therapeutic approaches to the disease. English articles on this topic have been searched by Medline. A particular attention has been paid to experimental therapeutic interventions supported by in vivo results. Three different novel strategies have been identified: 1) To act on estrogenic dependence of endometriosis using new drugs such as aromatase inhibitors and raloxifene. These drugs may have the advantage to act more specifically on the disease. 2) To treat the disease with immuno-modulators and anti-inflammatory drugs. These compounds may be helpful in both limiting the growth of endometriotic implants and in controlling the symptoms of the disease. 3) To prevent adhesion reformation after surgical lysis. Adhesions are an important hallmark of endometriosis which cannot be adequately eliminated by surgery. The use of barrier and fluid agents after surgical lysis seems to be effective in this regard. Results from studies aimed to investigate the effectiveness of these approaches are appealing. However, controlled clinical trials are now required to appropriately determine their real benefits and their specific indications.
Somigliana
E
E
II Clinica Ostetrico-Ginecologica, Clinica Luigi Mangiagalli, Università degli Studi di Milano, Milan, Italy.
Chiodini
A
A
Odorizzi
M P
MP
Pompei
F
F
Viganò
P
P
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D047072:Aromatase Inhibitors; D002986:Clinical Trials as Topic; D004353:Drug Evaluation, Preclinical; D004715:Endometriosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D020847:Estrogen Receptor Modulators / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology; D051379:Mice; D008807:Mice, Inbred BALB C; D008810:Mice, Inbred C57BL; D010215:Papio; D011247:Pregnancy; D018873:Pregnancy Rate; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D051381:Rats; D012008:Recurrence; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D000267:Tissue Adhesions / Q000517:prevention & control
D000276:Adjuvants, Immunologic; D000893:Anti-Inflammatory Agents; D047072:Aromatase Inhibitors; D004791:Enzyme Inhibitors; D020847:Estrogen Receptor Modulators; D020845:Selective Estrogen Receptor Modulators; D020849:Raloxifene Hydrochloride