Updates Of Medical Therapy For Endometriosis Literature Review: Literature Review

Abstract

Endometriosis is a benign uterine disease characterized by menstrual pain and infertility, which greatly affects women's health. It is a chronic disease that requires long-term care. Hormonal drugs are used for medical treatment and are based on the pathogenetic endocrine component. Estrogen dependence and progesterone resistance are the main causes of ectopic implantation of endometrial cells, reducing apoptosis and increasing oxidative stress, inflammation and neuroangiogenesis. Endometriotic cells express AMH, TGF-related factors (inhibin, activin, follistatin), CRH, and stress-related peptides. Endocrine and inflammatory changes explain infertility, pain, as well as a series of comorbidities that are described in these patients, such as autoimmune (thyroiditis, arthritis, allergies), inflammation (gastrointestinal disease / urinary disease), and mental health. Hormonal treatment of endometriosis aims to prevent menstruation by inhibiting the hypothalamus-pituitary-ovarian axis or by causing pseudodecidualization from amenorrhea, impairing the progress of endometriotic implantation. GnRH agonists and antagonists are effective in endometriosis by affecting the pituitary-ovarian function. Progestins are often used for long-term treatment (dienogest, NETA, MPA) and are used in many areas of practice. Combined oral contraceptives are also used to reduce the symptoms of endometriosis by inhibiting ovarian function. Clinical trials are currently underway for progesterone receptor modulators, selective estrogen receptor modulators and aromatase inhibitors. At this time, all these drugs are considered as the first treatment for women with endometriosis, to improve their symptoms, delay surgery or prevent the recurrence of the disease after surgery. This review aims to provide a comprehensive state of  current and future hormonal therapy for endometriosis .