Semin Reprod Med 2017; 35(01): 038-053
DOI: 10.1055/s-0036-1597308
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medical Management of Endometriosis in Patients with Chronic Pelvic Pain

Mohamed A. Bedaiwy
1  Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, The University of British Columbia, Vancouver, Canada
,
Catherine Allaire
1  Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, The University of British Columbia, Vancouver, Canada
,
Paul Yong
1  Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, The University of British Columbia, Vancouver, Canada
,
Sukinah Alfaraj
1  Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, The University of British Columbia, Vancouver, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
21 December 2016 (eFirst)

Abstract

Endometriosis is a common cause of pelvic pain in women of reproductive age. Traditional medical therapies are hormonal in nature, including estrogen–progestin contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) agonists. Other hormonal options are androgens and aromatase inhibitors, with research also suggesting a possible role for GnRH antagonists and selective progesterone receptor modulators. Other than nonsteroidal anti-inflammatories, further work is required for nonhormonal therapies such as antiangiogenic and immune-modulating drugs. Medical treatment of endometriosis can be complex, and requires consideration of side effects, the anatomic type of endometriosis, role of surgery, current infertility or future fertility desires, and other contributors to pain (e.g., central sensitization). These factors should be discussed for each patient, to ensure personalized treatment and optimal outcomes.