An Update on Pathophysiology and Medical Management of Endometriosis
An Update on Pathophysiology and Medical Management of Endometriosis作者机构：Department of Obstetrics and Gynaecology (Reproductive Neuroendocrinology and Infertility) Dr. Kulvinder Kaur Centre for Human Reproduction Jalandhar India Rotunda—A Centre for Human Reproduction Mumbai India
出 版 物：《Advances in Reproductive Sciences》 (生殖科学（英文）)
年 卷 期：2016年第4卷第2期
页 面：53-73页
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题：Antiangiogenic Agents Phytotherapeutics Drugs (Resveratrol) PPAR Gamma Agonism with AT1R Agonism (Telmesartan) GnRH Antagonist (Elagolix) IL-17A SPRM Modulators (Ulipristal) Immunomodulators (Pentoxyphylline) Statins (Atorvastatin)
摘 要：Endometriosis is an inflammatory oestrogen dependent disease defined by the presence of endometrial glands and stroma at extrauterine sites. The modern advance in treatment of endometriosis management is tackling the debilitating pain it causes, besides the infertility in patients desiring fertility in reproductive age group. This can be achieved by surgical or medical means, although in most cases a combination of both treatments is required. Usually, long term treatment is required in most cases. Unfortunately in most cases, pain symptoms recur between 6months and 12 months once treatment is stopped. A lot of research has gone in understanding the pathogenesis and further medical management of endometriosis besides surgery to be useful in relieving pain and use in patients desiring fertility besides hormonal treatments used earlier like hormonal contraceptives (oral, transdermal or vaginal administration), progestogens, danazol, Gonadotrophic releasing hormone agonist (GnRH), aromatase inhibitors. Newer agents like antiangiogenic drugs, phytochemical agents like resveratrol, TNF-α inhibitors, GnRH antagonists like egalogolix, statins, antiinflammatory agents like COX2 Inhibitors and PPARγ inhibitors like pioglitazone etc., with recent work of combined efficacy of telmesartan of both PPARγ partial agonism along with angiotensin 1 receptor agonism having more efficacy, role of immunomodulators like rapamycin, lipoxin 4 and pentoxyphylline, GnRH antagonists like egalogolix are still under study undergoing phase III trials although preliminary results show promising results with fewer side effects as compared to similar duration of GnRH agonist and much less BMD side effects. Increasing number of trials show the safety of SPRM’s, along with efficacy although disadvantage is suppression of fertility so cannot be used for women desiring fertility. Currently, only mifepristone and ulipristal have received FDA approval for indication in fibroid treatment, MTP and not for
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