Endometriosis in Focus: Modern Therapeutic Approaches for Enhanced Patient Outcomes - Review
DOI:
https://doi.org/10.12775/QS.2024.22.54897Keywords
endometriosis, endometriosis treatment, hormonal therapy, gnrh agonists, gnrh antagonists, pain relief, chronic pelvis pain, dietary management, aromatase inhibitors, alternative therapies for endometriosisAbstract
Endometriosis (EM) is a chronic condition affecting millions of women globally, characterized by the growth of endometrial-like tissue outside the uterus. This review highlights the latest advancements in understanding and treating endometriosis, focusing on new therapeutic strategies aimed at improving patient care.
The article briefly discusses the pathogenesis of endometriosis and reviews traditional treatment methods, including hormonal therapies (progestins, GnRH agonists, and oral contraceptives) and surgical interventions. It then explores the limitations of these conventional therapies and delves into newer strategies targeting specific molecular pathways, offering more effective symptom relief with fewer side effects.
Emerging treatments that modulate the immune response and reduce inflammation are also examined, along with innovative approaches to pain management, both pharmacological and non-pharmacological. The review further considers alternative and supportive therapies, such as dietary changes, gut microbiota interventions, and complementary treatments like acupuncture, which may improve the overall management of endometriosis.
This review emphasizes the shift toward more personalized, holistic care in treating endometriosis, with a focus on emerging therapies like Aromatase Inhibitors, GnRH receptor antagonists, and hormone receptor modulators. These approaches represent a significant advancement in improving the quality of life for women with this condition.
References
Becker K, Heinemann K, Imthurn B, Marions L, Moehner S, Gerlinger C, i in. Real world data on symptomology and diagnostic approaches of 27,840 women living with endometriosis. Sci Rep. 14 październik 2021;11(1):20404.
Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 10 marzec 2014;2014(3):CD009590.
França PR de C, Lontra ACP, Fernandes PD. Endometriosis: A Disease with Few Direct Treatment Options. Molecules. 23 czerwiec 2022;27(13):4034.
Hadfield R, Mardon H, Barlow D, Kennedy S. Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK. Hum Reprod. kwiecień 1996;11(4):878–80.
Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL. Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod. kwiecień 2003;18(4):756–9.
Husby GK, Haugen RS, Moen MH. Diagnostic delay in women with pain and endometriosis. Acta Obstet Gynecol Scand. lipiec 2003;82(7):649–53.
Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 26 marzec 2020;382(13):1244–56.
Kalaitzopoulos DR, Samartzis N, Kolovos GN, Mareti E, Samartzis EP, Eberhard M, i in. Treatment of endometriosis: a review with comparison of 8 guidelines. BMC Womens Health. 29 listopad 2021;21(1):397.
Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. listopad 2019;15(11):666–82.
Velasco I, Rueda J, Acién P. Aromatase expression in endometriotic tissues and cell cultures of patients with endometriosis. Mol Hum Reprod. czerwiec 2006;12(6):377–81.
De Almeida Asencio F, Ribeiro HA, Ayrosa Ribeiro P, Malzoni M, Adamyan L, Ussia A, i in. Symptomatic endometriosis developing several years after menopause in the absence of increased circulating estrogen concentrations: a systematic review and seven case reports. Gynecol Surg. grudzień 2019;16(1):3.
Javert CT. Pathogenesis of endometriosis based on endometrial homeoplasia, direct extension, exfoliation and implantation, lymphatic and hematogenous metastasis, including five case reports of endometrial tissue in pelvic lymph nodes. Cancer. maj 1949;2(3):399–410.
Jerman LF, Hey-Cunningham AJ. The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biol Reprod. marzec 2015;92(3):64.
Lu Z, Zhang W, Jiang S, Zou J, Li Y. Effect of oxygen tensions on the proliferation and angiogenesis of endometriosis heterograft in severe combined immunodeficiency mice. Fertil Steril. luty 2014;101(2):568–76.
Vercellini P, Crosignani P, Somigliana E, Viganò P, Buggio L, Bolis G, i in. The „incessant menstruation” hypothesis: a mechanistic ovarian cancer model with implications for prevention. Hum Reprod. wrzesień 2011;26(9):2262–73.
Shi J, Tan X, Feng G, Zhuo Y, Jiang Z, Banda S, i in. Research advances in drug therapy of endometriosis. Front Pharmacol. 21 czerwiec 2023;14:1199010.
Buggio L, Somigliana E, Barbara G, Frattaruolo MP, Vercellini P. Oral and depot progestin therapy for endometriosis: towards a personalized medicine. Expert Opin Pharmacother. październik 2017;18(15):1569–81.
Griffiths MJ, Horne AW, Gibson DA, Roberts N, Saunders PTK. Endometriosis: recent advances that could accelerate diagnosis and improve care. Trends Mol Med. 10 lipiec 2024;S1471-4914(24)00166-7.
Working group of ESGE, ESHRE and WES. Recommendations for the surgical treatment of endometriosis Part 2: deep endometriosis †‡¶. Facts Views Vis Obgyn. 27 marzec 2020;11(4):269–97.
Li XY, Chao XP, Leng JH, Zhang W, Zhang JJ, Dai Y, i in. Risk factors for postoperative recurrence of ovarian endometriosis: long-term follow-up of 358 women. J Ovarian Res. 30 sierpień 2019;12(1):79.
Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. wrzesień 2012;98(3):511–9.
Pavone ME, Bulun SE. Aromatase inhibitors for the treatment of endometriosis. Fertil Steril. grudzień 2012;98(6):1370–9.
Ferrero S, Evangelisti G, Barra F. Current and emerging treatment options for endometriosis. Expert Opin Pharmacother. lipiec 2018;19(10):1109–25.
Polyzos NP, Fatemi HM, Zavos A, Grimbizis G, Kyrou D, Velasco JG, i in. Aromatase inhibitors in post-menopausal endometriosis. Reprod Biol Endocrinol. 21 czerwiec 2011;9:90.
Taylor HS, Giudice LC, Lessey BA, Abrao MS, Kotarski J, Archer DF, i in. Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist. N Engl J Med. 6 lipiec 2017;377(1):28–40.
Klingmüller D, Schepke M, Enzweiler C, Bidlingmaier F. Hormonal responses to the new potent GnRH antagonist Cetrorelix. Acta Endocrinologica. styczeń 1993;128(1):15–8.
Ford MR, Turner MJ, Wood C, Soutter WP. Endometriosis developing during tamoxifen therapy. Am J Obstet Gynecol. maj 1988;158(5):1119.
Harada T, Ohta I, Endo Y, Sunada H, Noma H, Taniguchi F. SR-16234, a Novel Selective Estrogen Receptor Modulator for Pain Symptoms with Endometriosis: An Open-label Clinical Trial. Yonago Acta Med. grudzień 2017;60(4):227–33.
Pellicer N, Galliano D, Herraiz S, Bagger YZ, Arce JC, Pellicer A. Use of dopamine agonists to target angiogenesis in women with endometriosis. Hum Reprod. 18 marzec 2021;36(4):850–8.
Yarmolinskaya M, Suslova E, Tkachenko N, Molotkov A, Kogan I. Dopamine agonists as genital endometriosis target therapy. Gynecol Endocrinol. 2020;36(sup1):7–11.
Nishimoto-Kakiuchi A, Sato I, Nakano K, Ohmori H, Kayukawa Y, Tanimura H, i in. A long-acting anti-IL-8 antibody improves inflammation and fibrosis in endometriosis. Sci Transl Med. 22 luty 2023;15(684):eabq5858.
Wu Q, Liang Z, Jiang J, Feng X, Liu J, Zhang Z, i in. Macrophages originated IL-33/ST2 inhibits ferroptosis in endometriosis via the ATF3/SLC7A11 axis. Cell Death Dis. 11 październik 2023;14(10):668.
El-Zayadi AA, Mohamed SA, Arafa M, Mohammed SM, Zayed A, Abdelhafez MS, i in. Anti-IL-6 receptor monoclonal antibody as a new treatment of endometriosis. Immunol Res. grudzień 2020;68(6):389–97.
Kalaitzopoulos DR, Lempesis IG, Athanasaki F, Schizas D, Samartzis EP, Kolibianakis EM, i in. Association between vitamin D and endometriosis: a systematic review. Hormones (Athens). czerwiec 2020;19(2):109–21.
Nirgianakis K, Egger K, Kalaitzopoulos DR, Lanz S, Bally L, Mueller MD. Effectiveness of Dietary Interventions in the Treatment of Endometriosis: a Systematic Review. Reprod Sci. styczeń 2022;29(1):26–42.
Moore JS, Gibson PR, Perry RE, Burgell RE. Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol. kwiecień 2017;57(2):201–5.
Mira TAA, Buen MM, Borges MG, Yela DA, Benetti-Pinto CL. Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis. Int J Gynaecol Obstet. październik 2018;143(1):2–9.
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