Pinto da Costa Viana Diogo, Jacobsen Leonardo, Padovesi Igor, Comin Ana, Correia Eline Lobo de Souza, Fernandes Daniela Da Maia, Dias Ana Carolina Pires
Brazilian Society of Endocrinology and Metabolism in Sports and Exercise, Florianópolis 88070-800, Brazil.
Sociedade Brasileira de Pesquisa e Ensino em Medicina, São Paulo 01318-901, Brazil.
Biomedicines. 2025 Sep 18;13(9):2294. doi: 10.3390/biomedicines13092294.
: The management of endometriosis-associated pain has traditionally focused on analgesic efficacy. However, with high-level evidence demonstrating therapeutic equivalence among principal hormonal classes, the paradigm has shifted towards a patient-centred approach prioritising long-term tolerability and shared decision-making. Objectives: This review critically synthesises the evidence for the three main hormonal therapies-gonadotropin-releasing hormone (GnRH) analogues, dienogest, and gestrinone-focusing on their distinct tolerability and safety profiles to inform this modern clinical framework. : This narrative review followed the SANRA (Scale for the Assessment of Narrative Review Articles) guidelines. The literature search was performed in PubMed, Embase, and Web of Science in June 2025. : Our comparative analysis, based on a structured literature search adhering to SANRA guidelines, shows that while all three classes are effective, they present distinct benefit-risk profiles: GnRH analogues offer potent pain relief but induce a hypoestrogenic state requiring add-back therapy to mitigate bone loss and vasomotor symptoms; dienogest preserves bone mineral density but is associated with challenging bleeding patterns and potential mood disturbances; gestrinone provides robust efficacy with a favourable cardiovascular and skeletal safety profile, although its androgenic effects can significantly impact patient adherence. : In the absence of a clear hierarchy of efficacy, the optimal therapeutic choice is not determined by potency, but by a collaborative process in which patient values and tolerance for specific adverse effects guide selection. This review provides a framework to facilitate this shared decision-making (SDM) in clinical practice.
子宫内膜异位症相关疼痛的管理传统上侧重于镇痛效果。然而，随着高级别证据表明主要激素类别之间的治疗等效性，范式已转向以患者为中心的方法，优先考虑长期耐受性和共同决策。目的：本综述批判性地综合了三种主要激素疗法——促性腺激素释放激素（GnRH）类似物、地诺孕素和孕三烯酮——的证据，重点关注它们不同的耐受性和安全性概况，以为这一现代临床框架提供信息。：本叙述性综述遵循了SANRA（叙述性综述文章评估量表）指南。文献检索于2025年6月在PubMed、Embase和科学网进行。：我们基于遵循SANRA指南的结构化文献检索进行的比较分析表明，虽然所有这三类药物都有效，但它们呈现出不同的获益-风险概况：GnRH类似物可有效缓解疼痛，但会诱发低雌激素状态，需要添加反向疗法来减轻骨质流失和血管舒缩症状；地诺孕素可保持骨矿物质密度，但与具有挑战性的出血模式和潜在的情绪障碍有关；孕三烯酮具有强大的疗效，心血管和骨骼安全性良好，尽管其雄激素作用会显著影响患者的依从性。：在缺乏明确的疗效等级的情况下，最佳治疗选择不是由效力决定的，而是由一个协作过程决定的，在这个过程中，患者的价值观和对特定不良反应的耐受性指导选择。本综述提供了一个框架，以促进临床实践中的这种共同决策（SDM）。
