Hormonal treatments for endometriosis: The endocrine background

Abstract

Endometriosis is a benign uterine disorder characterized by menstrual pain and infertility, deeply affecting women’s health. It is a chronic disease and requires a long term management. Hormonal drugs are currently the most used for the medical treatment and are based on the endocrine pathogenetic aspects. Estrogen-dependency and progesterone-resistance are the key events which cause the ectopic implantation of endometrial cells, decreasing apoptosis and increasing oxidative stress, inflammation and neuroangiogenesis. Endometriotic cells express AMH, TGF-related growth factors (inhibin, activin, follistatin) CRH and stress related peptides. Endocrine and inflammatory changes explain pain and infertility, and the systemic comorbidities described in these patients, such as autoimmune (thyroiditis, arthritis, allergies), inflammatory (gastrointestinal/urinary diseases) and mental health disorders.The hormonal treatment of endometriosis aims to block of menstruation through an inhibition of hypothalamus-pituitary-ovary axis or by causing a pseudodecidualization with consequent amenorrhea, impairing the progression of endometriotic implants. GnRH agonists and antagonists are effective on endometriosis by acting on pituitary-ovarian function. Progestins are mostly used for long term treatments (dienogest, NETA, MPA) and act on multiple sites of action. Combined oral contraceptives are also used for reducing endometriosis symptoms by inhibiting ovarian function. Clinical trials are currently going on selective progesterone receptor modulators, selective estrogen receptor modulators and aromatase inhibitors. Nowadays, all these hormonal drugs are considered the first-line treatment for women with endometriosis to improve their symptoms, to postpone surgery or to prevent post-surgical disease recurrence. This review aims to provide a comprehensive state-of-the-art on the current and future hormonal treatments for endometriosis, exploring the endocrine background of the disease.

Tata Laksana Terkini untuk Endometriosis

“…Saat ini, pengobatan hormonal adalah obat yang paling efektif untuk pengobatan endometriosis, dengan cara penghambatan aksis hipotalamuspituitari-ovarium dan pseudodesidualisasi yang menghambat proses implantasi jaringan endometriotik ektopik. 33 Tabel 5. Terapi hormonal endometriosis 34,35 • Progestogen…”

Targeting Oxidative Stress Involved in Endometriosis and Its Pain

“…Risk factors include early menarche, late menopause, and nulliparity, all of which increase the number of lifetime ovulatory cycles [ 5 ]. Common clinical symptoms include irregular uterine bleeding, painful intercourse (dyspareunia), and painful periods (dysmenorrhea) [ 6 , 7 ]. As there is no cure for endometriosis and the pathophysiology remains unclear, common treatment options target relieving symptoms but do not address the underlying mechanisms of the disease [ 8 ].…”

Internet-based cognitive behavioral therapy for improving health-related quality of life in patients with endometriosis: study protocol for a randomized controlled trial

“…Surgical treatment is directed at ablating or excising endometriotic tissue. Pharmacological treatment is often directed at either symptomatic relief of pain through the use of analgesics (e.g., non-steroidal anti-inflammatory drugs) or at reducing circulating estrogen to a constantly lower level [ 31 ], leading to reduced ovarian function, less pain and inhibition in further growth of endometriotic tissue [ 32 ].…”