Medical Management of Endometriosis

Abstract

The successful treatment of endometriosis-associated symptoms typically requires surgical as well as medical intervention. Progestogens are efficacious and inexpensive treatment of pelvic endometriosis. A variety of medications have been used as add-back therapy in addition to gonadotrophin-releasing hormone (GnRH) agonist for treatment of endometriosis which includes progestogen alone, progestogen and estrogen combination, or progestogen and bisphosphonates. GnRH antagonists have been used for the treatment of pelvic endometriosis; however, they have not been as widely accepted as GnRH agonists. Selective progesterone receptor modulators introduce a new dimension in the medical treatment of endometriosis. Aromatase inhibitors which inhibit estrogen production in endometriotic implants are an attractive option for the management of endometriosis. Antiangiogenesis therapy has been investigated in rodents, demonstrated that angiostatic agents prevent the development of endometriosis-like lesions in the chicken chorioallantoic membrane. Nonsteroidal inflammatory drugs are very helpful in pelvic pain and dysmenorrhea associated with endometriosis.