However, hormonal treatment also impedes conception, excluding this approach in women wishing to conceive. īased on the role of retrograde menstruation according to Sampson’s theory, blocking ovulation and menstruation by means of hormonal therapies may in theory be disease-modulating and control the symptoms of endometriosis. Nevertheless, one common pathogenic mechanism shared by all forms of the condition is the impact of estradiol (E2), which is known to have proinflammatory and antiapoptotic effects on endometrial cells, especially in ectopic foci. There are three distinct forms of the disease (peritoneal, ovarian and rectovaginal endometriosis) and each of them may be associated with specific symptoms, although dysmenorrhea and chronic non-menstrual pelvic pain are the most prevalent. Between 5% and 10% of women of reproductive age are affected. The aim of this review is to present, based on recent literature, various medical options for the management of symptomatic endometriosis, a common chronic inflammatory disease causing pain and infertility. Conclusion: There is a place for GnRH antagonists in the management of symptomatic endometriosis and clinical trials should be conducted, taking into account the different phenotypes in order to propose novel algorithms. ![]() The efficacy of three oral GnRH antagonists is discussed on the basis of published studies. Biochemical, histological and clinical evidence show that estrogens play a critical role in the pathogenesis of endometriosis, so lowering levels of circulating estrogens should be considered an effective medical approach. It is clear that there is a need for effective long-term oral treatment capable of managing endometriosis symptoms, while mitigating the impact of side effects. ![]() Results: Having reviewed the most significant papers, we can confirm that OCPs and progestogens are effective in two-thirds of women suffering from endometriosis, but that other options are required in case of failure (in one-third of women due to progesterone resistance) or intolerance to these compounds. Eleven papers, essentially reviews, were selected and scrutinized from among 94 papers discussing the concept of progesterone resistance. Methods: We reviewed the most relevant papers ( n = 73) on the efficacy of OCPs and progestogens as medical therapy for endometriosis, as well as those on progesterone resistance and new medical alternatives (oral gonadotropin-releasing hormone (GnRH) antagonist). The second objective was to review the concept of progesterone resistance and newly available treatment options. Background: The first objective of this review was to present, based on recent literature, the most frequently applied medical options (oral contraceptive pills (OCPs) and progestogens) for the management of symptomatic endometriosis, and evaluate their effectiveness in treating premenopausal women with endometriosis-associated pelvic pain, dysmenorrhea, non-menstrual pelvic pain and dyspareunia.
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