Data di Pubblicazione:
2011
Citazione:
Waiting for Godot : a commonsense approach to the medical treatment of endometriosis / P. Vercellini, P. Crosignani, E. Somigliana, P. Vigano', M.P. Frattaruolo, L. Fedele. - In: HUMAN REPRODUCTION. - ISSN 0268-1161. - 26:1(2011), pp. 3-13. [10.1093/humrep/deq302]
Abstract:
abstract: 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.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
endometriosis; medical treatment; oral contraceptives; pelvic pain; progestins
Elenco autori:
P. Vercellini, P. Crosignani, E. Somigliana, P. Vigano', M.P. Frattaruolo, L. Fedele
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