Systemic therapy in endometriosis: alternatives to hormone therapy

Braun J., Schäfer S., Kiesel L.

Abstract

Background: Endometriosis is a one of the most common, benign but chronic diseases in women of reproductive age. The main symptoms are chronic and as a rule cycle-dependent pelvic pain and infertility. The etiology and pathogenesis of endometriosis are still unclear, a curative therapy is still lacking and the established options for therapy are mostly symptomatic. Other than surgical removal in this case laparoscopy is the gold standard, drug therapy plays an important role. In cases of infertility there is often an indication for assisted reproductive treatment. Discussion: The main aim of drug therapy is to achieve a hypoestrogenic state; therefore, oral contraceptives, gestagens and gonadotropin-releasing hormone (GnRH) analogues are used. Experimental options include aromatase inhibitors, GnRH antagonists, selective estrogen receptor modulators (SERM) and selective progesterone receptor modulators (SPRM). Furthermore, nonsteroidal anti-inflammatory drugs (NSAIRs), cyclooxygenase (COX)-2 inhibitors, angiogenesis inhibitors and immunomodulators can also be used. Conclusion: Especially for women with severe pelvic pain syndrome a multimodal pain therapy should be offered, for example, acupuncture, physiotherapy or phytotherapy are complementary treatment options, although not being evidence based. This study gives an overview of current non-invasive non-hormonal treatment options.