Medical Therapy of Endometriosis

Abstract

The medical treatment of endometriosis is a critical aspect of the therapeutic approach to this disease. Past methods have been based upon systemic hormonal alterations, resulting in suppression of this estrogen-responsive disorder. Treatments such as danazol, progestogens, oral contraceptives, GnRH-agonists, and gestrinone achieve their effects upon endometriosis via this method. However, with a growing understanding of the pathogenesis of this disease, more precise molecular targets for treatment have been identified. Thus, a series of newer agents are under development and hold the potential of greater efficacy and flexibility than traditional treatments. This review analyzes the available and experimental medical treatments of endometriosis, their utility in the treatment of pain and infertility, and their role in the future.

Genetic variation in the sex hormone metabolic pathway and endometriosis risk: an evaluation of candidate genes

“…Additional support for the estrogen-dependent nature of endometriosis is evidenced by endometriotic lesion regression in some women after treatment with estrogen-suppressing drugs (including progesterone) or gonadotropin-releasing hormone (GnRH) agonists and relapse of lesions after discontinuation of treatment (10). Studies have evaluated endometriosis risk associated with single nucleotide polymorphisms (SNPs) in genes involved in the biosynthesis of and response to estrogen and progesterone, including: CYP17A1, CYP19A1, ESR1, ESR2, PGR, HSD17B1, and HSD17B2 , SNPs in genes involved in synthesis of catecholestrogen, including: CYP1A1 and CYP1A2, and SNPs in genes involved in inactivation of estrogen, catecholestrogen or its products including COMT (11–13).…”

Catamenial pneumothorax in a 14-year-old female: A case report and literature review

“…Taking a continuous dose of combined estrogen-progestin diminishes ovarian function and suppresses ovulation. Oral contraceptives are preferred over GnRH agonists in the treatment of endometriosis as they have a milder side effect profile and can be used more long term [6]. Procedures such as thoracotomy with pleural abrasion and salpingo-oophorectomy are considered in some patients who continue to experience endometriosis related symptoms despite medical management.…”

LC-MS/MS Detection of Increased Androstenedione Levels in Patients Receiving Danazol Therapy

“…Danazol is a 17-ethinyl testosterone derivative (1). It has multiple levels of action, which include suppression of pituitary gonadotropin secretion, direct inhibition of endometriotic implant growth, and direct inhibition of ovarian enzymes responsible for estrogen production (1).…”

“…It has multiple levels of action, which include suppression of pituitary gonadotropin secretion, direct inhibition of endometriotic implant growth, and direct inhibition of ovarian enzymes responsible for estrogen production (1). Danazol has long been used in the management of endometriosis, however its reported immunomodulatory effects such as reducing interleukin-1 and TNF-α have led to the use of danazol in management of immune related conditions such as idiopathic thrombocytopenic purpura (ITP) and aplastic anemia(1,2,3,4) . The side effects associated with danazol are largely due to its androgenic effects (1).…”

“…Danazol has long been used in the management of endometriosis, however its reported immunomodulatory effects such as reducing interleukin-1 and TNF-α have led to the use of danazol in management of immune related conditions such as idiopathic thrombocytopenic purpura (ITP) and aplastic anemia(1,2,3,4) . The side effects associated with danazol are largely due to its androgenic effects (1). Danazol has been reported to act as an interference in the immunoassay measurement of various androgens (including androstenedione), resulting in falsely elevated values for these hormones (5).…”