Pathogenesis, diagnosis and treatment of genital endometriosis

The etiology of genital endometriosis remains unclear, but it is evident that persisting endometriotic foci are stimulated by ovarian steroid hormones. Many cases are treated by surgery either via laparotomy or pelviscopy. Endocrine treatments with testosterone, gestagens, danazol and gestrinone have also been used to some effect. Recently developed analogs of gonadotropin-releasing hormone (GnRH) have demonstrated the high binding capacities of receptors involved in the down-regulation of the normal cycle which result in atrophy of the endometrium. These agents could therefore be used in the treatment of endometriosis. To date, 924 patients with pelvic endometriosis have been treated in our department with conventional endocrine therapies, 40 patients were treated with buserelin (D-Ser (Bu)6 luteinizing hormone-releasing hormone monopeptide-ethylamide), 900 micrograms/day intranasally, and 50 patients with goserelin depot, a GnRH analog of D-Ser (Bu)6- Azegly10-GnRH, with depot applications (3.6 mg per 4 weeks). The stage of development of endometriosis was determined using the endoscopic endometriosis classification prior to and after endocrine treatment. A complete check of the pelvis was carried out each time and a careful revision of the endometriotic foci undertaken. Endocrine treatment of endometriosis allowed 60% of previously sterile patients to become pregnant. Ovarian function in these patients was normal. The analogs proved to be clinically effective, safe and were well tolerated. Gestrinone proved to be the endocrine treatment of preference.