Abstract
Endometriosis is associated with painful symptoms, infertility, sexological difficulties, and psychological suffering. All these symptoms have a negative impact on the overall quality of life of women with the disease, with significant personal, social and economic costs. Several medical options are available to manage symptomatic endometriosis. The pharmacological treatment for endometriosis-related pain may be necessary for decades, or at least until there is a desire for pregnancy or physiologic menopause occurs. In this perspective, clinicians should consider not only the efficacy, but also side effects, tolerability, and costs, along with women's preferences toward different treatments. In this mini-review, we analyzed the pros and cons of the available drugs for the medical therapy of endometriosis, such as estrogen-progestins, progestins, GnRH agonist and GnRH antagonists.
Highlights
Several medical options are available to manage symptomatic endometriosis, a chronic inflammatory estrogen-dependent disease characterized by the presence and proliferation of endometrium outside the uterine cavity [1,2,3,4]
It would be very helpful for women with endometriosis if GnRH antagonists will be compared with progestins in pragmatic trials
This appears important if one considers the chronic nature of the disease, potentially determining a long-term impairment of women’s overall quality of life, mental health, social activities, work, sexual and intimate relationships
Summary
Several medical options are available to manage symptomatic endometriosis, a chronic inflammatory estrogen-dependent disease characterized by the presence and proliferation of endometrium outside the uterine cavity [1,2,3,4]. The European Society of Human Reproduction and Embryology (ESHRE) guidelines on endometriosis [24] pointed out that, the evidence on the use of estrogen-progestins for endometriosis is limited, combined hormonal contraception is extensively used as a treatment for endometriosis-associated pain This may be due to pragmatic and reasonable benefits of the estrogen-progestins therapy in women affected by endometriosis, including contraceptive action, few side effects, long term safety and good control of uterine bleeding. All these characteristics of the estrogen-progestins have a positive impact on the overall tolerability of the medical treatment and in general on patients’ quality of life. High adherence and low dropout rates have been reported with the use of progestins for the management of endometriosis-associated pain [1, 19]
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