Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy.
Expert Rev Clin Pharmacol. 2022 Sep;15(9):1039-1052. doi: 10.1080/17512433.2022.2117155. Epub 2022 Aug 30.
Endometriosis is a chronic, estrogen-dependent, inflammatory disease associated with pelvic pain, infertility, impaired sexual function, and psychological suffering. Therefore, tailored patient management appears of primary importance to address specific issues and identify the appropriate treatment for each woman. Over the years, abundant research has been carried out with the objective to find new therapeutic approaches for this multifaceted disease.
This narrative review aims to present the latest advances in the pharmacological management of endometriosis. In particular, the potential role of GnRH antagonists, selective progesterone receptor modulators (SPRMs), and selective estrogen receptors modulators (SERMs) will be discussed. We performed a literature search in PubMed and Embase, and selected the best quality evidence, giving preference to the most recent and definitive original articles and reviews.
Medical therapy represents the cornerstone of endometriosis management, although few advances have been made in the last decade. Most studies have focused on the evaluation of the efficacy and safety of GnRH antagonists (plus add-back therapy in cases of prolonged treatment), which should be used as second-line treatment options in selected cases (i.e. non-responders to first-line treatments). Further studies are needed to identify the ideal treatment for women with endometriosis.
子宫内膜异位症是一种慢性、雌激素依赖性、炎症性疾病,与盆腔疼痛、不孕、性功能障碍和心理痛苦有关。因此,针对特定问题制定个体化的患者管理方案并为每位女性确定合适的治疗方法显得尤为重要。多年来,已经开展了大量研究,旨在为这种多方面的疾病寻找新的治疗方法。
本综述旨在介绍子宫内膜异位症药物治疗的最新进展。特别讨论了 GnRH 拮抗剂、选择性孕激素受体调节剂 (SPRMs) 和选择性雌激素受体调节剂 (SERMs) 的潜在作用。我们在 PubMed 和 Embase 上进行了文献检索,选择了最佳质量的证据,优先考虑最近和最权威的原始文章和综述。
药物治疗是子宫内膜异位症管理的基石,但在过去十年中几乎没有取得进展。大多数研究都集中在评估 GnRH 拮抗剂(在延长治疗的情况下加用补充疗法)的疗效和安全性,这些药物应作为特定情况下(即一线治疗无反应者)的二线治疗选择。需要进一步的研究来确定子宫内膜异位症女性的理想治疗方法。