title: Advances in pharmacotherapy for treating endometriosis.
abstract: BACKGROUND
  Endometriosis is an estrogen-dependent chronic disease requiring long-term therapy. Therefore, the choice of medical treatment should be based on efficacy, preference of patients, incidence and severity of adverse effects and cost.
  
  
  METHODS
  This review briefly summarizes the currently available medical treatment for endometriosis. The treatments most recently proposed for endometriosis will be described in detail, including gonadotropin-releasing hormone (GnRH) antagonists, aromatase inhibitors (AIs) and the flexible extended combined oral contraceptive.
  
  
  CONCLUSIONS
  The oral contraceptive pill and progestogens allow for the treatment of the majority of patients with endometriosis. The flexible extended dosing regimen, containing drospirenone and ethinylestradiol, may be particularly useful in patients suffering severe dysmenorrhea and improving the adherence and compliance with treatment. GnRH agonists may be used in patients resistant to first-line therapy; up to now, limited data are available on the use of GnRH antagonist (such as elagolix) in patients with endometriosis. AIs should be regarded as experimental therapies and used only in patients with symptoms resistant to other therapies; however, the use of these drugs is limited by the possibility to administer the treatment for short-term periods only (6 months) and, similarly to GnRH antagonists, by the high incidence of adverse effects, requiring the use of add-back therapy.
authors.affiliation: a 1 Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST , Largo R. Benzi 10, Genova, Italy +39 0 10 51 15 25 ; +39 01 08 93 28 43 ; simone.ferrero@unige.it.|b 2 University of Genova, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , Genova, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Tafi
authors.affiliation: a 1 Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST , Largo R. Benzi 10, Genova, Italy +39 0 10 51 15 25 ; +39 01 08 93 28 43 ; simone.ferrero@unige.it.
authors.forename: Umberto
authors.initials: U
authors.lastname: Leone Roberti Maggiore
authors.affiliation: a 1 Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST , Largo R. Benzi 10, Genova, Italy +39 0 10 51 15 25 ; +39 01 08 93 28 43 ; simone.ferrero@unige.it.
authors.forename: Franco
authors.initials: F
authors.lastname: Alessandri
authors.affiliation: c 3 IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Department of Obstetrics and Gynecology , 19 Viale Camillo Golgi, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bogliolo
authors.affiliation: c 3 IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Department of Obstetrics and Gynecology , 19 Viale Camillo Golgi, Pavia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gardella
authors.affiliation: d 4 University of Genoa, Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC) , Genoa, Italy.
authors.forename: Valerio Gaetano
authors.initials: VG
authors.lastname: Vellone
authors.affiliation: d 4 University of Genoa, Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC) , Genoa, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Grillo
authors.affiliation: d 4 University of Genoa, Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC) , Genoa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Mastracci
authors.affiliation: a 1 Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST , Largo R. Benzi 10, Genova, Italy +39 0 10 51 15 25 ; +39 01 08 93 28 43 ; simone.ferrero@unige.it.|b 2 University of Genova, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , Genova, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Ferrero
mesh_terms: D000736:Androstenes / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use; D004715:Endometriosis / Q000188:drug therapy*; D004997:Ethinyl Estradiol / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D011372:Progestins / Q000627:therapeutic use
chemical_list: D000736:Androstenes; D000894:Anti-Inflammatory Agents, Non-Steroidal; D047072:Aromatase Inhibitors; D003277:Contraceptives, Oral, Combined; D006727:Hormone Antagonists; D011372:Progestins; D007987:Gonadotropin-Releasing Hormone; D004997:Ethinyl Estradiol; C035144:drospirenone
keywords: aromatase inhibitors; endometriosis; flexible extended combined oral contraceptive; gonadotropin-releasing hormone antagonist