Tafi Emanuela, Leone Roberti Maggiore Umberto, Alessandri Franco, Bogliolo Stefano, Gardella Barbara, Vellone Valerio Gaetano, Grillo Federica, Mastracci Luca, Ferrero Simone
a 1 Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST , Largo R. Benzi 10, Genova, Italy +39 0 10 51 15 25 ; +39 01 08 93 28 43 ;
b 2 University of Genova, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , Genova, Italy.
Expert Opin Pharmacother. 2015;16(16):2465-83. doi: 10.1517/14656566.2015.1085510. Epub 2015 Sep 7.
Endometriosis is an estrogen-dependent chronic disease requiring long-term therapy. Therefore, the choice of medical treatment should be based on efficacy, preference of patients, incidence and severity of adverse effects and cost.
This review briefly summarizes the currently available medical treatment for endometriosis. The treatments most recently proposed for endometriosis will be described in detail, including gonadotropin-releasing hormone (GnRH) antagonists, aromatase inhibitors (AIs) and the flexible extended combined oral contraceptive.
The oral contraceptive pill and progestogens allow for the treatment of the majority of patients with endometriosis. The flexible extended dosing regimen, containing drospirenone and ethinylestradiol, may be particularly useful in patients suffering severe dysmenorrhea and improving the adherence and compliance with treatment. GnRH agonists may be used in patients resistant to first-line therapy; up to now, limited data are available on the use of GnRH antagonist (such as elagolix) in patients with endometriosis. AIs should be regarded as experimental therapies and used only in patients with symptoms resistant to other therapies; however, the use of these drugs is limited by the possibility to administer the treatment for short-term periods only (6 months) and, similarly to GnRH antagonists, by the high incidence of adverse effects, requiring the use of add-back therapy.
子宫内膜异位症是一种依赖雌激素的慢性疾病，需要长期治疗。因此，药物治疗的选择应基于疗效、患者偏好、不良反应的发生率和严重程度以及成本。
本综述简要总结了目前可用的子宫内膜异位症药物治疗方法。将详细描述最近提出的子宫内膜异位症治疗方法，包括促性腺激素释放激素（GnRH）拮抗剂、芳香化酶抑制剂（AIs）和灵活延长联合口服避孕药。
口服避孕药和孕激素可用于治疗大多数子宫内膜异位症患者。含有屈螺酮和炔雌醇的灵活延长给药方案可能对患有严重痛经的患者特别有用，并可提高治疗的依从性和顺应性。GnRH激动剂可用于一线治疗耐药的患者；到目前为止，关于GnRH拮抗剂（如艾拉戈利）在子宫内膜异位症患者中的使用数据有限。AIs应被视为实验性疗法，仅用于对其他疗法耐药的患者；然而，这些药物的使用受到仅能短期给药（6个月）的限制，并且与GnRH拮抗剂类似，不良反应发生率高，需要使用反向添加疗法。
