Department of Obstetrics and Gynecology, University of Connecticut, Farmington, CT, USA -
Department of Obstetrics and Gynecology, University of Connecticut, Farmington, CT, USA.
Minerva Obstet Gynecol. 2021 Oct;73(5):572-587. doi: 10.23736/S2724-606X.21.04776-X. Epub 2021 Jul 15.
Endometriosis is a benign gynecologic disorder that is defined as functional endometrial tissue outside of the uterine cavity. It is an estrogen-dependent, inflammatory disease that leads to symptoms of pelvic pain, dysmenorrhea, dyspareunia, and infertility, occurring in 6-10% of reproductive aged women. The severity of the disease ranges from asymptomatic to debilitating symptoms that have a major impact on women's lives. It is a chronic, recurrent disease, frequently requiring long term management until menopause and beyond. It is considered a chronic disorder that is managed with surgery, medical treatment, and oftentimes, both. Current medical therapy for endometriosis is considered suppressive of the disease, rather than curative. Fortunately, many patients do experience improvement and control of their symptoms with medical therapy. However, long-term efficacy of the medical treatments is often limited by side effects and the cost of therapy, and symptoms do tend to recur after discontinuation of these medications. This review summarizes our understanding of the pathogenesis of endometriosis and provides more in-depth discussion of specific medical management options used to treat endometriosis, including mechanism of action and side effects. It also provides recommendations on strategy with a forward look to novel endometriosis treatments in the future. The authors emphasized that endometriosis is a chronic disorder requiring long term medical therapy. Early diagnosis of endometriosis is key in preventing severe, debilitating symptoms and progression of disease. By utilizing our current knowledge of the pathophysiology of endometriosis and by correctly implementing currently available medical and surgical therapies we can significantly reduce the physical, psychosocial and financial burden of this chronic, recurrent and indolent disease. Current available medications are suppressive therapies, but the authors are looking forward to future therapies that can effectively cure or at least control endometriosis with minimal side effects. Future research should continue to look for the genetic trigger for endometriosis which can lead us to its underlying pathogenesis and eventually a cure or prevention.
子宫内膜异位症是一种良性妇科疾病，定义为子宫腔外的功能性子宫内膜组织。它是一种雌激素依赖性、炎症性疾病，导致盆腔疼痛、痛经、性交困难和不孕，发生在 6-10%的育龄妇女中。疾病的严重程度从无症状到使患者衰弱的症状不等，对女性的生活有重大影响。它是一种慢性、复发性疾病，经常需要长期管理，直到绝经后甚至更久。它被认为是一种慢性疾病，需要手术、药物治疗，并且常常需要两者结合。目前治疗子宫内膜异位症的医学疗法被认为是抑制疾病，而不是治愈疾病。幸运的是，许多患者确实通过药物治疗改善和控制了他们的症状。然而，这些药物治疗的长期疗效往往受到副作用和治疗费用的限制，并且在停止这些药物治疗后症状往往会复发。本文综述了我们对子宫内膜异位症发病机制的理解，并对用于治疗子宫内膜异位症的具体医学管理选择进行了更深入的讨论，包括作用机制和副作用。它还就未来的新型子宫内膜异位症治疗方法提供了策略建议。作者强调，子宫内膜异位症是一种需要长期药物治疗的慢性疾病。早期诊断子宫内膜异位症是预防严重、使患者衰弱的症状和疾病进展的关键。通过利用我们对子宫内膜异位症病理生理学的现有知识，并正确实施现有的医学和手术治疗方法，我们可以显著减轻这种慢性、复发性和惰性疾病的身体、心理社会和经济负担。目前可用的药物是抑制性治疗，但作者期待未来的治疗方法能够有效地治愈或至少控制子宫内膜异位症，同时副作用最小。未来的研究应继续寻找子宫内膜异位症的遗传触发因素，这可以使我们了解其潜在的发病机制，最终实现治愈或预防。
