Local drug release systems in endometriosis

n recent years, the research involved to clarify the mechanisms of endometriosis development has opened up new innovative treatments. In fact, not only have new drugs been studied but also new routes of administration for hormones have been investigated. The intrauterine and/or vaginal administration of progestins, such as levonorgestrel and danazol, seems to answer to some problems related to the long-term management of endometriosis in terms of efficacy and compliance. The medical treatment of endometriosis is significantly influenced by poor compliance and several systemic side-effects. In fact, although a wide armory of medical therapies already exists, the choice depends on patient preference after an appropriate discussion of risks, side-effects and costs. Concerning the hormonal treatment of this pelvic pathology, the European Society for Human Reproduction & Embryology guidelines [1] Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E, on behalf of the ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005; 20: 2698–2704 [Crossref], [PubMed], [Web of Science ®], , [Google Scholar] for the diagnosis and treatment of endometriosis affirm (level of evidence A) that ‘suppression of ovarian function for 6 months reduces endometriosis associated pain’. The hormonal drugs investigated (combined oral contraceptives, danazol, gestrinone, medroxyprogesterone acetate and gonadotropin-releasing hormone agonists) are equally effective, but their side-effects and cost profiles differ.