Suardika Anom, Astawa Pemayun Tjokorda Gede
Department of Obstetrics and Gynecology, Udayan University, Sangah Hospital, Bali, Indonesia
J Turk Ger Gynecol Assoc. 2018 Aug 6;19(3):158-164. doi: 10.4274/jtgga.2018.0090. Epub 2018 Jul 16.
Endometriosis is a disease of theories, but none has succeeded to explain the whole picture. Most widely available drugs for endometriosis aim to relieve symptoms and improve fertility. Unfortunately, many short and long-term side-effects are associated with the treatments. To overcome this problem, researchers have developed many novel therapeutic agents, including non-invasive technique. We aim to provide new insights on pathogenesis model and novel non-surgical treatments for endometriosis, including drugs already available in the market and also drugs which are still under research. Seven novel treatment modalities are recognized, namely dienogest, aromatase inhibitor (AI), gonadotrophine-releasing hormone (GnRH) antagonist, anti tumor necrosing factor (TNF)-α, selective estrogen receptor modulator (SERM), selective progesterone receptor modulator (SPRM), and high-intensity focused ultrasound (HIFU). Dienogest, AI, and GnRH antagonists are effective novel treatments with good tolerance and safety. SERM and SPRM show inconsistent results, while anti-TNF-α is still in the animal experimental stage. HIFU is a potential futuristic treatment. However, it is still a long way until this technology is truly applicable.
子宫内膜异位症是一种充满各种理论的疾病，但尚无一种理论能够全面解释其发病机制。目前治疗子宫内膜异位症最常用的药物旨在缓解症状并提高受孕几率。遗憾的是，这些治疗方法都伴有许多短期和长期的副作用。为解决这一问题，研究人员开发了许多新型治疗药物，包括非侵入性技术。我们旨在为子宫内膜异位症的发病机制模型及新型非手术治疗方法提供新的见解，其中包括市场上已有的药物以及仍在研究中的药物。目前已确认七种新型治疗方式，即地诺孕素、芳香化酶抑制剂（AI）、促性腺激素释放激素（GnRH）拮抗剂、抗肿瘤坏死因子（TNF）-α、选择性雌激素受体调节剂（SERM）、选择性孕激素受体调节剂（SPRM）以及高强度聚焦超声（HIFU）。地诺孕素、AI和GnRH拮抗剂是有效的新型治疗药物，耐受性和安全性良好。SERM和SPRM的治疗效果并不一致，而抗TNF-α仍处于动物实验阶段。HIFU是一种具有潜力的未来治疗方法。然而，要使这项技术真正得到应用仍有很长的路要走。
