Abstract
Endometriosis is a chronic gynecological condition that affects approximately 10% of women of reproductive age, characterized by the presence of endometrial tissue outside the uterus, mainly affecting women in this age group. This article addresses advances in the clinical treatment of endometriosis, emphasizing pharmacological and hormonal approaches available in recent years. The review explores the effectiveness of GnRH analogs, progestins, nonsteroidal anti-inflammatory drugs (NSAIDs), and emerging therapies such as selective progesterone receptor modulators. It is concluded that personalized treatment, based on factors such as age, symptom severity, and fertility desire, is essential for effective management.
Keywords: Endometriosis; Reproductive age; Fertility; Hormonal therapy.
Current clinical treatments aim to control symptoms, reduce disease progression, and preserve fertility. The therapeutic approach includes the use of GnRH analogs, which induce a hypoestrogenic state, as well as progestins, which promote the atrophy of ectopic tissue. Alternatives such as NSAIDs for pain control and new pharmacological options, such as selective progesterone receptor modulators, expand the range of treatment possibilities. In this context, scientific advancements have enabled a better understanding of the disease's pathophysiological mechanisms, resulting in personalized and innovative treatments.
Objectives
This
article aims to evaluate advances in the clinical treatments of endometriosis,
emphasizing the evolution of hormonal therapies, alternative approaches, and
their impact on the quality of life of affected women.
Materials and Methods
A
bibliographic review was conducted using articles published in the PUBMED,
ScienceDirect, and Scielo databases to support the study.
Discussion
Endometriosis remains a significant clinical challenge due to
the complexity of its presentation and the diversity of responses to
treatments. Among conventional therapies, GnRH analogs remain a cornerstone,
reducing estrogen levels and promoting lesion regression. However, associated
side effects, such as climacteric symptoms, limit their prolonged use.
Progestins, in turn, are widely used due to their low cost and favorable safety
profile. Medications such as dienogest and medroxyprogesterone have proven effective
in pain relief and lesion reduction, although they may cause changes in
menstrual patterns. Recently, selective progesterone receptor modulators, such
as elagolix, have shown promising efficacy in managing moderate to severe
endometriosis. These agents act selectively, offering a more tolerable side
effect profile, expanding therapeutic possibilities. Clinical studies indicate
that this class of drugs may gradually replace traditional options in
refractory cases.
Furthermore, complementary approaches, such as nutritional interventions and stress management techniques, have shown benefits in some patients, highlighting the importance of a multidisciplinary approach. Despite this, study heterogeneity makes it difficult to standardize protocols. Although significant advances have been made, late diagnosis remains a major obstacle, leading to disease progression and impairment of quality of life. The inclusion of biomarkers for early diagnosis and the incorporation of personalized therapies can improve prognosis and reduce the disease's impact.
Conclusion
Endometriosis
remains a significant clinical challenge, requiring multidimensional approaches
for effective management. Recent advances in hormonal and alternative therapies
offer new hope for patients, especially those who do not respond to
conventional treatments. However, the lack of a definitive cure underscores the
need for further research focused on less invasive and more effective
treatments. An integrated approach combining pharmacological therapies,
psychological support, and complementary interventions may be the most
promising path. Additionally, investing in awareness campaigns is essential to
reduce diagnostic delays and promote access to appropriate treatments. By
prioritizing individualized and integrated care, it is expected to significantly
improve the quality of life of women affected by endometriosis.
References
1. Agarwal
SK, et al. Endometriosis and infertility. Fertility and Sterility 2021;116(5):1151-1160.
2. Becker
CM, et al. Anti-TNF therapy in the treatment of endometriosis: A review of the
evidence. Human Reproduction Update 2010;16(4):539-545.
3. Becker
CM, et al. new approaches to treatment of endometriosis. Best Practice
Research Clinical Obstetrics Gynaecology 2021;71(1):72-82.
4. Bulun SE. Endometriosis. The New England J
Med 2019;380(1):1244-1256.
5. Chapron C, Dubuisson JB. Diagnosing deep
endometriosis. Human Reproduction 2019;34(2):236-249.
7. Giudice LC. Clinical practice.
Endometriosis. The New
England J Med 2018;362(25):2389-2398.
8. Greene
AD, et al. Endometriosis and mental health. Obstetrical Gynecological
Survey 2017;72(9):563-581.
11. Leonardi M, et al. Effectiveness of
hormonal treatments for endometriosis-associated pain. J Minimally
Invasive Gynecology 2020;27(1):145-154.
12. McKinnon BD, et al. Mechanisms of pain in
endometriosis. Climacteric 2020;23(6):473-478.
13. Morotti
M, et al. Quality of life in endometriosis patients. J Psychosomatic
Obstetrics Gynecology 2017;38(3):201-209.
14. Olovsson
M. Surgical and medical management of endometriosis. The Lancet 2022;399(10343):839-849.