Vercellini Paolo, Somigliana Edgardo, Viganò Paola, Abbiati Annalisa, Barbara Giussy, Crosignani Pier Giorgio
Clinica Ostetrica e Ginecologica I, University of Milan, Milan, Italy.
Drugs. 2009;69(6):649-75. doi: 10.2165/00003495-200969060-00002.
Endometriosis is a chronic inflammatory condition that is responsive to management with steroids. The establishment of a steady hormonal environment and inhibition of ovulation can temporarily suppress ectopic implants and reduce inflammation as well as associated pain symptoms. In terms of pharmacological management, the currently available agents are not curative, and treatment often needs to be continued for years or until pregnancy is desired. Similar efficacy has been observed from the various therapies that have been investigated for endometriosis. Accordingly, combined oral contraceptives and progestins, based on their favourable safety profile, tolerability and cost, should be considered as first-line options, as an alternative to surgery and for post-operative adjuvant use. In situations where progestins and oral contraceptives prove ineffective, are poorly tolerated or are contraindicated, gonadotrophin-releasing hormone analogues, danazol or gestrinone may be used. Future therapeutic options for managing endometriosis must compare favourably against existing agents before they can be considered for inclusion into current practice. Finally, as reproductive prognosis is not ameliorated by medical treatment, it is not indicated for women seeking conception.
子宫内膜异位症是一种对类固醇治疗有反应的慢性炎症性疾病。建立稳定的激素环境和抑制排卵可暂时抑制异位植入物，并减轻炎症以及相关的疼痛症状。在药物治疗方面，目前可用的药物无法治愈该疾病，治疗通常需要持续数年或直到有怀孕需求为止。对已研究的各种子宫内膜异位症治疗方法观察到了相似的疗效。因此，基于其良好的安全性、耐受性和成本，复方口服避孕药和孕激素应被视为一线选择，可作为手术的替代方法以及术后辅助用药。在孕激素和口服避孕药被证明无效、耐受性差或禁忌的情况下，可使用促性腺激素释放激素类似物、达那唑或孕三烯酮。未来用于治疗子宫内膜异位症的治疗方法在被纳入当前临床实践之前，必须比现有药物具有更好的疗效。最后，由于药物治疗并不能改善生殖预后，因此不适合寻求受孕的女性。
