Endometriosis – therapy

Endometriosis is an unpredictable, aggressive and invasive disease. Frequently there is no correlation between the severity of endometriosis and chronic pelvic pain. In addition the measurement of the pain is difficult to estimate. There have been no published clinical trials that have compared directly surgical and medical therapy for chronic pelvic pain and endometriosis. The adhesive disease is best treated by surgery especially in cases of infertility. Near contact laparoscopy may identify very small lesions, remove them and give histological confirmation which is a standard for research study. Following initial laparoscopy the use of medical treatment prior to final surgery is helpful. Postoperative use of hormones is controversial. Different surgical treatment must be individualized. In 0.7-1.0% endometriosis may undergo malignant transformation therefore the identification of suspected loci is necessary. Medical therapy for dysmenorrhea and dyspareunia is successful but the recurrence rate is high. Hormonal therapy has to suppress the ovarian steroids and induce a hypoestrogenic state. It includes combined oral contraceptives, progestogens, danazol and GnRH agonists. These various drugs are comparable in terms of efficacy, but different in costs and side effects. Among the novel potential candidate drugs immunomodulators and anti-inflammatory agents are under research in animal models. Other types of drugs (aromatase inhibitors and SERM) are also currently tested.