An update on the pharmacological management of endometriosis.
BACKGROUND
Endometriosis is a common disease that causes pain symptoms and/or infertility in women in their reproductive years. The disease is characterised by the presence of endometrium-like tissue - glands and stroma - outside the uterine cavity. Different treatment options exist for endometriosis including medical and surgical treatments or a combination of the two approaches. The most commonly used medications are non-steroidal anti-inflammatory drugs, GnRH agonists, androgen derivatives such as danazol, combined oral contraceptive pills, progestogens and more recently the levonorgestrel intrauterine system.


METHODS
The authors review current medical treatments used for symptomatic endometriosis and also discuss new treatment approaches. The authors conducted a literature search for randomised controlled trials related to medical treatments of endometriosis in humans, searched the Cochrane library for reviews and also searched for registered trials that have not yet been published on ClinicalTrials.gov.


CONCLUSIONS
The medical treatment of endometriosis is effective at treating pain and preventing recurrence of disease after surgery. Remarkably, the oral contraceptive pill taken continuously is as effective as GnRH-a, while causing far less side-effects. Conversely, no treatment currently exists for enhancing fecundity in women whose infertility is associated with endometriosis. As all existing therapies of endometriosis are contraceptive, great efforts should be targeted at researching novel products that reduce the disease expression without shuttering ovulation.
Service de gynécologie, obstétrique et médecine de la reproduction, Groupe hospitalier du centre Cochin -- Broca -- Hôtel-Dieu, CHU Cochin, Paris, France.
Isabelle
I
Streuli
Dominique
D
de Ziegler
Pietro
P
Santulli
Louis
L
Marcellin
Bruno
B
Borghese
Frédéric
F
Batteux
Charles
C
Chapron
D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects / Q000627:therapeutic use; D004715:Endometriosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D055502:Secondary Prevention
D000894:Anti-Inflammatory Agents, Non-Steroidal; D003277:Contraceptives, Oral, Combined; D007987:Gonadotropin-Releasing Hormone