Hormonal strategy for the primary or secondary treatment of endometriosis

Endometriosis is a chronic inflammatory disease characterized by dysmenorrhea, dyspareunia and infertility, which may be treated surgically and/or medically. The medical treatment of endometriosis may be used as a first-line option, as an alternative to surgery and for postoperative adjuvant use. The most commonly used drugs are hormones, which act via two major strategies: iatrogenic menopause and pseudopregnancy. In both cases, the goal is to create a steady hormonal environment with inhibition of ovulation, suppressing the ectopic implants and reducing the inflammatory status as well as the associated pain symptoms. The blockade of the growth and activity of endometriotic lesions is obtained, and long-term or repeated courses of medication may be required to control symptoms. To obtain reduced ovarian activity, gonadotropin-releasing hormone analogs, gonadotropin-releasing hormone analog antagonists or aromatase inhibitors are currently used or are under investigation. Pseudopregnancy is obtained by the use of progestins or oral estroprogestins; based on their favorable safety profile, tolerability and cost, they should be considered as primary intervention. The future perspective is to use a multiple approach for treating women with endometriosis with the goal of eradicating the disease and eliminating the symptoms.