Medical Treatment for Endometriosis: One Size Does Not Fit All

Area of Science:

• Gynecology
• Reproductive Endocrinology
• Pain Management

Background:

• Endometriosis causes significant nociceptive pain and sensitization.
• Effective endometriosis management requires integrating scientific evidence, clinical expertise, and patient values.

Purpose of the Study:

• To review hormonal treatments for symptomatic endometriosis.
• To interpret treatment data considering clinical experience and patient preferences.

Main Methods:

• Comprehensive narrative review of randomized controlled trials and meta-analyses.
• Interpretation of data through clinical experience and patient-defined trade-offs.

Main Results:

• First-line (progestogens, estrogen-progestogens) and second-line (GnRH analogues) hormonal therapies benefit most symptomatic patients.
• Body-identical estrogens are preferred over ethinyl-estradiol to minimize thrombosis risk.
• Irregular bleeding is a key adverse effect of first-line treatments.

Conclusions:

• Hormonal therapy is crucial for endometriosis pain relief, aiming for ovariostasis and amenorrhea.
• Prompt escalation to GnRH analogues with add-back therapy is indicated if first-line treatments fail.
• Secondary prevention in adolescents and young women is vital for HRQoL and reproductive preservation.