Pharmacotherapy of endometriosis in reproductive gynaecology

Česká verzia

Authors: R. Hudeček; G. Jelenek; Michal Felsinger
Authors place of work: Gynekologicko-porodnická klinika, LF MU a FN Brno
Published in the journal: Prakt Gyn 2011; 15(2): 70-77
Category: Review Article

Summary

Endometriosis is defined as an ectopic presence of endometrial tissue outside the uterine cavity causing a chronic inflammatory reaction. Aetiology of endometriosis is most likely multifactorial; retrograde menstruation is a very popular theory, though immune system appears to play an important role. The signs and symptoms of endometriosis include chronic pelvic pain, irregular and strong menstrual bleeding, bleeding between periods, dyspareunia and fertility disorders. The paper provides an overview of the current options available for classification of endometriosis of the lesser pelvis, summarizes epidemiological factors and pathogenetic mechanisms pertaining to the localization of ectopic foci. The paper defines possible clinical signs of the various forms of endometriosis and provides an overview of current options for pharmacological treatment. Hormonal treatment options include administration of oral contraception, progestin-only pills (POP), depot progestins – implants, intrauterine system (IUS) with levonorgestrel, progestins with respect to the results of recent clinical trials with dienogest. Furthermore, therapeutic effects of selective progesterone receptor modulators (SPRM), GnRH analogues and antagonists and Add-back therapy are presented. The overview is completed with a discussion on therapeutic options provided by selective estrogen receptor modulators (SERM), selective aromatase inhibitors (AI) and anti-inflammatory and immunomodulatory therapy. The decision to use pharmacological or surgical treatment of genital forms of endometriosis, or their combination, should be based on the type of endometriosis being treated, i.e. whether this is peritoneal, ovarian, rectovaginal or extragenital form or adenomyosis. The character of pelvic pain and the presence of infertility also influence the choice of suitable therapeutic approach. Microscopic description of ectopic endometrial foci also affects the final outcome of hormonal therapy.

Key words:
endometriosis – pharmacotherapy of endometriosis – infertility – dysmenorrhoea - dyspareunia

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