title: Advances in the management of endometriosis: an update for clinicians.
abstract: Endometriosis is a chronic and recurrent disease characterized by the presence and proliferation of endometrial tissue outside the uterine cavity, which occurs in approximately 10% of women of reproductive age. In this estrogen-dependent disorder, lesions become inactive and gradually undergo regression during states of ovarian down-regulation, such as amenorrhoea or menopause. The impact of endometriosis includes impaired fertility potential, as well as symptoms of dysmenorrhoea, dyspareunia and chronic non-menstrual pain, all of which adversely affect quality of life. Management of endometriosis focuses on pain relief and includes medical and surgical treatment. Pharmacologic therapies currently in use include combination oral contraceptives (COCs), danazol, GnRH analogues and progestins. Although some agents show efficacy in relieving pain, all differ in their side effects, making it difficult to achieve a balance between efficacy and safety. Efficacy has been demonstrated with danazol or GnRH analogues; however, treatment is limited to 6 months because of significant metabolic side effects. Alternatives for longer-term management of symptoms include add-back therapy with GnRH analogues, COCs or progestins. Newer options for treatment of endometriosis include depot medroxyprogesterone acetate subcutaneous injection, as well as several agents under investigation that may prove to have therapeutic potential.
authors.affiliation: I Clinica Obstetrica e Ginecologica, Universita di Milano, Milan, Italy. piergiorgio.crosignani@unimi.it
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Crosignani
authors.forename: David
authors.initials: D
authors.lastname: Olive
authors.forename: Agneta
authors.initials: A
authors.lastname: Bergqvist
authors.forename: Anthony
authors.initials: A
authors.lastname: Luciano
mesh_terms: D047072:Aromatase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use; D003613:Danazol / Q000627:therapeutic use; D004715:Endometriosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D020847:Estrogen Receptor Modulators / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use; D006728:Hormones / Q000008:administration & dosage; D006801:Humans; D011372:Progestins / Q000627:therapeutic use; D011788:Quality of Life; D011980:Receptors, Progesterone / Q000187:drug effects
chemical_list: D047072:Aromatase Inhibitors; D003277:Contraceptives, Oral, Combined; D020847:Estrogen Receptor Modulators; D006728:Hormones; D011372:Progestins; D011980:Receptors, Progesterone; D007987:Gonadotropin-Releasing Hormone; D003613:Danazol