Published on PubMed: October, 2022

Endometriosis is a benign chronic inflammatory disease defined as the presence of endometrium outside of the uterine cavity. The disease affects 10% of women in reproductive age; it is mainly characterized by dysmenorrhea and infertility, affecting the quality of life

Dysmenorrhea, chronic pelvic pain, dyschezia, dysuria, dyspareunia, and infertility are common symptoms in endometriosis patients.

The therapeutic strategy needs to be tailored to each patient according to symptoms, age, and pregnancy desire. It includes surgery, medical therapy, and assisted reproductive technology (ART).

Since endometriosis is a chronic condition in reproductive age women, the medical approach is the primary choice for improving symptoms, preventing or treating recurrences, and planning surgery or ART. 

TAKE HOME MESSAGE

Hormonal drugs, by blocking menstruation, are the most effective for the treatment of endometriosis-related pain, independently of phenotype (ovarian, deep, or superficial endometriosis).

Gonadotropin-releasing hormone analogs and oral antagonists act on hypothalamus-pituitary-ovary axis inducing iatrogenic menopause, thus reducing dysmenorrhea and all pain symptoms. The side effects, such as hot flushes and bone loss, may be reduced by an add-back therapy.

However, the cost in terms of women's health remains high in view of a long-term treatment. Progestins are considered the first-line treatment, highly effective, and with reduced side effects.

Conclusions

The modern management of endometriosis aims to avoid repeated surgical procedures and the associated risks. Since endometriosis is a chronic disease, the cornerstone of its management is the long-term medical treatment. As several evidences suggested an endocrine pathogenesis for endometriosis, hormonal treatments are currently the most effective drugs for the treatment of the disease.

In addition to the well-known and largely used Norethisterone acetate and Medroxyprogesterone acetate, recently Dienogest has become one of the most used drugs in all endometriosis phenotypes for long-term treatment.

Besides, intrauterine levornogestrel or subcutaneous etonogestrel are valid alternatives for long-term treatment.