| 'Waiting for Godot': a commonsense approach to the medical treatment of endometriosis. | |
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MedLine Citation:
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PMID: 21071490 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Conservative surgical treatment for symptomatic endometriosis is frequently associated with only partial relief of pelvic pain or its recurrence. Therefore, medical therapy constitutes an important alternative or complement to surgery. However, no available compound is cytoreductive, and suppression instead of elimination of implants is the only realistic objective of pharmacological intervention. Because this implies prolonged periods of treatments, only medications with a favourable safety/tolerability/efficacy/cost profile should be chosen. In the past few years, innumerable new drugs for endometriosis, which would interfere with several hypothesized pathogenic mechanisms, have been studied and their use foreseen. However, robust evidence of in vivo safety and efficacy is lacking and, at the moment, the principal modality to interfere with endometriosis metabolism is still hormonal manipulation. Regrettably, in spite of consistent demonstration of a major effect on pain even in patients with deeply infiltrating lesions, progestins are underestimated and dismissed in favour of more scientifically fashionable and up-to-the-minute alternatives. Moreover, oral contraceptives (OCs) dramatically reduce the rate of post-operative endometrioma recurrence and should now be considered an essential part of long-term therapeutic strategies in order to limit further damage to future fertility. Finally, women who have used OC for prolonged periods will be protected from an increased risk of endometriosis-associated ovarian cancer. To avoid the several subtle modalities for distorting facts and orientating opinions in favour of specific compounds, progestins and monophasic OC used continuously are here proposed as the reference comparator in all future randomized controlled trials on medical treatment for endometriosis. |
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Authors:
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Paolo Vercellini; PierGiorgio Crosignani; Edgardo Somigliana; Paola Viganò; Maria Pina Frattaruolo; Luigi Fedele |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-11-11 |
Journal Detail:
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Title: Human reproduction (Oxford, England) Volume: 26 ISSN: 1460-2350 ISO Abbreviation: Hum. Reprod. Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2010-12-23 Completed Date: 2011-04-26 Revised Date: 2011-07-06 |
Medline Journal Info:
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Nlm Unique ID: 8701199 Medline TA: Hum Reprod Country: England |
Other Details:
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Languages: eng Pagination: 3-13 Citation Subset: IM |
Affiliation:
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Department of Obstetrics and Gynaecology, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy. paolo.vercellini@unimi.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Contraceptives, Oral
/
adverse effects,
therapeutic use* Drug Toxicity Drugs, Investigational / adverse effects, therapeutic use Endometriosis / drug therapy*, prevention & control, surgery Female Humans Randomized Controlled Trials as Topic Recurrence / prevention & control |
| Chemical | |
Reg. No./Substance:
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0/Contraceptives, Oral; 0/Drugs, Investigational |
| Comments/Corrections | |
Comment In:
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Hum Reprod. 2011 Jun;26(6):1600-1; author reply 1601-2
[PMID:
21441541
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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