Human Reproduction Update Advance Access originally published online on November 9, 2005
Human Reproduction Update 2006 12(2):179-189; doi:10.1093/humupd/dmi049
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Advances in the management of endometriosis: an update for clinicians
1 I Clinica Obstetrica e Ginecologica, Universita di Milano, Milan, Italy, 2 University of Wisconsin, Madison, WI, USA, 3 Karolinska Institutet Department of Medical Epidemiology and Biostatistics, Stockholm and 4 University of Connecticut School of Medicine, New Britain General Hospital, New Britain, CT, USA
5 To whom correspondence should be addressed at: I Clinica Obstetrica e Ginecologica, Universita di Milano, Via Commenda 12, 20122 Milan, Italy. E-mail: piergiorgio.crosignani{at}unimi.it
Submitted on July 1, 2005; resubmitted on October 3, 2005; accepted on October 7, 2005
Endometriosis is a chronic and recurrent disease characterized by the presence and proliferation of endometrial tissue outside the uterine cavity, which occurs in approximately 10% of women of reproductive age. In this estrogen-dependent disorder, lesions become inactive and gradually undergo regression during states of ovarian down-regulation, such as amenorrhoea or menopause. The impact of endometriosis includes impaired fertility potential, as well as symptoms of dysmenorrhoea, dyspareunia and chronic non-menstrual pain, all of which adversely affect quality of life. Management of endometriosis focuses on pain relief and includes medical and surgical treatment. Pharmacologic therapies currently in use include combination oral contraceptives (COCs), danazol, GnRH analogues and progestins. Although some agents show efficacy in relieving pain, all differ in their side effects, making it difficult to achieve a balance between efficacy and safety. Efficacy has been demonstrated with danazol or GnRH analogues; however, treatment is limited to 6 months because of significant metabolic side effects. Alternatives for longer-term management of symptoms include add-back therapy with GnRH analogues, COCs or progestins. Newer options for treatment of endometriosis include depot medroxyprogesterone acetate subcutaneous injection, as well as several agents under investigation that may prove to have therapeutic potential.
Key words: androgens / endometriosis / GnRH (AG/ANTAG) / progesterone / surgery
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