Medical Treatments for Endometriosis-Associated Pelvic Pain

Abstract

The main sequelae of endometriosis are represented by infertility and chronic pelvic pain. Chronic pelvic pain causes disability and distress with a very high economic impact. In the last decades, an impressive amount of pharmacological agents have been tested for the treatment of endometriosis-associated pelvic pain. However, only a few of these have been introduced into clinical practice. Following the results of the controlled studies available, to date, the first-line treatment for endometriosis associated pain is still represented by oral contraceptives used continuously. Progestins represent an acceptable alternative. In women with rectovaginal lesions or colorectal endometriosis, norethisterone acetate at low dosage should be preferred. GnRH analogues may be used as second-line treatment, but significant side effects should be taken into account. Nonsteroidal anti-inflammatory drugs are widely used, but there is inconclusive evidence for their efficacy in relieving endometriosis-associated pelvic pain. Other agents such as GnRH antagonist, aromatase inhibitors, immunomodulators, selective progesterone receptor modulators, and histone deacetylase inhibitors seem to be very promising, but there is not enough evidence to support their introduction into routine clinical practice. Some other agents, such as peroxisome proliferator activated receptors-γ ligands, antiangiogenic agents, and melatonin have been proven to be efficacious in animal studies, but they have not yet been tested in clinical studies.

Systemische Therapie der Endometriose: Alternativen zur Hormontherapie

“…Sie kommen in allen Lebewesen vor, beim Menschen in allen Gewebetypen. Derzeit wird vermutet, dass verschiedene epigenetische Aberrationen in der Pathogenese der Endometriose von Bedeutung sind [27]. Neuere Studien untersuchten die Rolle der HDAC im Rahmen der Endometriose und testeten Histon-Deacetylase-Inhibitoren (HDCAI) zu deren Behandlung.…”

“…Zu diesen erprobten Stoffen gehören Rosiglitazon, Ciglitazon, Pioglitazon sowie Thiazolidinedion [23,27].…”

The role of melatonin in development of gestational diabetes mellitus

“…Это дает осно-вание полагать наличие у них патологии диф-фузной нейроиммуноэндокринной системы, ведущим гормоном которой является мелато-нин -регулятор гомеостаза, обеспечивающий функциональную взаимосвязь нейрокринных, эндокринных и паракринных механизмов [19,20]. Следует подчеркнуть, что при всех пере-численных выше формах патологии, определя-ющих риск развития ГСД, исследователи отме-чают низкий уровень мелатонина в организме и нарушение его циркадных изменений [21][22][23][24][25][26][27][28].…”

Combined treatment of endometriosis in infertile patients with gonadotropin-releasing hormone agonist or dienogest

“…Большое количество исследований показало эффек-тивность диеногеста для лечения эндометриоз-ассо-циированной боли [12][13][14][15][16]. K. Sugimoto [17] доказа-на эффективность и безопасность применения пре-парата у больных с эндометриозом более 53 нед.…”