title: Medical treatments for endometriosis-associated pelvic pain.
abstract: The main sequelae of endometriosis are represented by infertility and chronic pelvic pain. Chronic pelvic pain causes disability and distress with a very high economic impact. In the last decades, an impressive amount of pharmacological agents have been tested for the treatment of endometriosis-associated pelvic pain. However, only a few of these have been introduced into clinical practice. Following the results of the controlled studies available, to date, the first-line treatment for endometriosis associated pain is still represented by oral contraceptives used continuously. Progestins represent an acceptable alternative. In women with rectovaginal lesions or colorectal endometriosis, norethisterone acetate at low dosage should be preferred. GnRH analogues may be used as second-line treatment, but significant side effects should be taken into account. Nonsteroidal anti-inflammatory drugs are widely used, but there is inconclusive evidence for their efficacy in relieving endometriosis-associated pelvic pain. Other agents such as GnRH antagonist, aromatase inhibitors, immunomodulators, selective progesterone receptor modulators, and histone deacetylase inhibitors seem to be very promising, but there is not enough evidence to support their introduction into routine clinical practice. Some other agents, such as peroxisome proliferator activated receptors-γ ligands, antiangiogenic agents, and melatonin have been proven to be efficacious in animal studies, but they have not yet been tested in clinical studies.
authors.affiliation: Department of Medical Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
authors.forename: Gabriella
authors.identifier: 0000-0002-7836-4934
authors.initials: G
authors.lastname: Zito
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Luppi
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy.
authors.forename: Elena
authors.identifier: 0000-0001-6677-9553
authors.initials: E
authors.lastname: Giolo
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy.
authors.forename: Monica
authors.identifier: 0000-0002-1277-1713
authors.initials: M
authors.lastname: Martinelli
authors.affiliation: Department of Medical Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
authors.forename: Irene
authors.identifier: 0000-0002-2720-1668
authors.initials: I
authors.lastname: Venturin
authors.affiliation: Department of Medical Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
authors.forename: Giovanni
authors.identifier: 0000-0002-8845-1206
authors.initials: G
authors.lastname: Di Lorenzo
authors.affiliation: Department of Medical Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy ; Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ricci
mesh_terms: D004715:Endometriosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D056572:Histone Deacetylase Inhibitors / Q000627:therapeutic use*; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D059408:Pain Management; D017699:Pelvic Pain / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D011372:Progestins / Q000627:therapeutic use*
chemical_list: D056572:Histone Deacetylase Inhibitors; D006727:Hormone Antagonists; D011372:Progestins; D007987:Gonadotropin-Releasing Hormone