Crosignani Piergiorgio, Olive David, Bergqvist Agneta, Luciano Anthony
I Clinica Obstetrica e Ginecologica, Universita di Milano, Milan, Italy.
Hum Reprod Update. 2006 Mar-Apr;12(2):179-89. doi: 10.1093/humupd/dmi049. Epub 2005 Nov 9.
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.
子宫内膜异位症是一种慢性复发性疾病，其特征是子宫腔外存在并增殖子宫内膜组织，约10%的育龄妇女会发生这种疾病。在这种雌激素依赖性疾病中，病变在卵巢功能下调状态（如闭经或绝经）下会变得不活跃并逐渐消退。子宫内膜异位症的影响包括生育能力受损，以及痛经、性交困难和慢性非经期疼痛等症状，所有这些都会对生活质量产生不利影响。子宫内膜异位症的治疗重点是缓解疼痛，包括药物治疗和手术治疗。目前使用的药物疗法包括复方口服避孕药（COC）、达那唑、GnRH类似物和孕激素。虽然一些药物在缓解疼痛方面显示出疗效，但它们的副作用各不相同，因此难以在疗效和安全性之间取得平衡。达那唑或GnRH类似物已证明具有疗效；然而，由于存在明显的代谢副作用，治疗仅限于6个月。症状的长期管理替代方案包括使用GnRH类似物、COC或孕激素进行反向添加疗法。子宫内膜异位症的新治疗选择包括醋酸甲羟孕酮皮下注射，以及几种正在研究的可能具有治疗潜力的药物。
