A Comprehensive Update on the Medical Treatment of Endometriosis-Correlated Pain Clinically with Emphasis over Pharmacokinetics, Pharmacodynamics, Biochemistry, Safety and Effectiveness of Accessible Options in a Condition not having Permanent Cure Till Date: A Narrative Review

Abstract

Having comprehensively reviewed the etiopathogenesis, medical, surgical therapies in addition to revival of surgery in endometriosis, in particular circumstances earlier here our main idea is to present the update of the available medical treatments, specifically in case of pain amelioration with emphasis over Pharmacokinetics, Pharmacodynamics, Biochemistry, Safety and effectiveness of currently accessible medical treatment for Endometriosis-correlated pain. Here we conducted a narrative review utilizing search engine PubMed, Google scholar, Web of science, Embase, Cochrane review library utilizing the Mesh terms like; endometriosis; medical treatments; Non Steroidal Anti Inflammatory Drugs (NSAIDS); Combined Oral contraceptives (COC); progestins; selective estrogen receptors modulators (SERM); selective Progesterone receptors modulators (SPRMs); Aromatase Inhibitors (AI); GnRH agonists; GnRH antagonists; Levonorgestrel releasing intra uterine system (LNG-IUS) from 1993 till April 2024.We found a total of 1500 articles out of which we selected 115 articles for this review. No meta-analysis was done. Thereby we have reviewed in detail pros &cons of various NSAIDS, COC’s, SERM’s, SERM’s tamoxifen Raloxifene, Bazedoxifene (BZA) fulvestrant of which are none clinically of use SPRMs, Progestins inclusive of medroxy progesterone acetate (MPA), Norethindrone acetate (NETA) and dienogest, of GnRH agonists-Leuprolide Acetate, of oral GnRH antagonist, relugolix linzagolix, elagolix, of AI’s letrozole, anastrazole, of the SPRMs mifepristone, Asoprisnil, ulipristal acetate (UPA) Vilaprisan & Lonaprisan of which till now only mifepristonel is of little use & UPA for select few where no history of liver disease of all these NSAIDS, COC’s, progestins need to be first line with them having better tolerability, efficacy and economical overall in contrast to 2nd line GnRH agonists, GnRH antagonists or AI’s. Dependent over this, key preferences are isolation of new noncontraceptive in addition to non-hormonal’ approaches for diminishing propagation of endometriosisis, thus chances of pregnancy getting feasible.