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Review

Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review

1
Société de Recherche pour l’Infertilité (SRI), 143 Avenue Grandchamp, 1150 Brussels, Belgium
2
Université Catholique de Louvain, 1200 Brussels, Belgium
3
Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium
4
Gynecology Department, Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium
*
Author to whom correspondence should be addressed.
Academic Editors: Jacek Szamatowicz and Jacek Malejczyk
J. Clin. Med. 2021, 10(5), 1085; https://doi.org/10.3390/jcm10051085
Received: 4 February 2021 / Revised: 20 February 2021 / Accepted: 26 February 2021 / Published: 5 March 2021
Background: The first objective of this review was to present, based on recent literature, the most frequently applied medical options (oral contraceptive pills (OCPs) and progestogens) for the management of symptomatic endometriosis, and evaluate their effectiveness in treating premenopausal women with endometriosis-associated pelvic pain, dysmenorrhea, non-menstrual pelvic pain and dyspareunia. The second objective was to review the concept of progesterone resistance and newly available treatment options. Methods: We reviewed the most relevant papers (n = 73) on the efficacy of OCPs and progestogens as medical therapy for endometriosis, as well as those on progesterone resistance and new medical alternatives (oral gonadotropin-releasing hormone (GnRH) antagonist). Eleven papers, essentially reviews, were selected and scrutinized from among 94 papers discussing the concept of progesterone resistance. Results: Having reviewed the most significant papers, we can confirm that OCPs and progestogens are effective in two-thirds of women suffering from endometriosis, but that other options are required in case of failure (in one-third of women due to progesterone resistance) or intolerance to these compounds. It is clear that there is a need for effective long-term oral treatment capable of managing endometriosis symptoms, while mitigating the impact of side effects. Biochemical, histological and clinical evidence show that estrogens play a critical role in the pathogenesis of endometriosis, so lowering levels of circulating estrogens should be considered an effective medical approach. The efficacy of three oral GnRH antagonists is discussed on the basis of published studies. Conclusion: There is a place for GnRH antagonists in the management of symptomatic endometriosis and clinical trials should be conducted, taking into account the different phenotypes in order to propose novel algorithms. View Full-Text
Keywords: endometriosis; pelvic pain; dysmenorrhea; oral contraceptive pills; progestogens; progesterone resistance; GnRH antagonist; add-back therapy endometriosis; pelvic pain; dysmenorrhea; oral contraceptive pills; progestogens; progesterone resistance; GnRH antagonist; add-back therapy
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MDPI and ACS Style

Donnez, J.; Dolmans, M.-M. Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review. J. Clin. Med. 2021, 10, 1085. https://doi.org/10.3390/jcm10051085

AMA Style

Donnez J, Dolmans M-M. Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review. Journal of Clinical Medicine. 2021; 10(5):1085. https://doi.org/10.3390/jcm10051085

Chicago/Turabian Style

Donnez, Jacques, and Marie-Madeleine Dolmans. 2021. "Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review" Journal of Clinical Medicine 10, no. 5: 1085. https://doi.org/10.3390/jcm10051085

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