Medical management of endometriosis-associated pain.
In the coming years, basic science research into the mechanisms of endometriosis development and persistence almost certainly will open new avenues for treatment. A wide armamentarium of medical therapies already exists, however. The efficacy of most of these methods in reducing endometriosis-associated pain is well established. The choice of which to use depends largely on patient preference after an appropriate discussion of risks, side effects, and cost. Typically, oral contraceptives and NSAIDs are first-line therapy because of their low cost and mild side effects (Box 6). Because of its greater potential for suppressing endometrial development, consideration should be given to prescribing a low-dose monophasic oral contraceptive continuously. If adequate relief is not obtained or if side effects prove intolerable, consideration should be given to the use of progestins (oral, intramuscular, or IUD) or a GnRH agonist with immediate add-back therapy. Progestins are less expensive, but GnRH agonists with add-back may be better tolerated. If none of these medications proves beneficial or if side effects are too pronounced, then repeat surgery is warranted. The surgery may have analgesic value and serves to reconfirm the diagnosis. Finally, if endometriosis is identified at the time of surgery, then consideration should be given to prescribing medical therapy postoperatively.
Mahutte
Neal G
NG
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA. neal.mahutte@yale.edu
Arici
Aydin
A
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003613:Danazol / Q000627:therapeutic use; D004715:Endometriosis / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D005867:Gestrinone / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D013509:Gynecologic Surgical Procedures; D006801:Humans; D015735:Mifepristone / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000209:etiology* / Q000601:surgery; D010147:Pain Measurement; D011372:Progestins / Q000627:therapeutic use; D012102:Reproductive Control Agents / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004965:Estrogen Antagonists; D011372:Progestins; D012102:Reproductive Control Agents; D005867:Gestrinone; D015735:Mifepristone; D007987:Gonadotropin-Releasing Hormone; D003613:Danazol