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Medical Therapies
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Simone Ferrero, Fabio Barra, Giulio Evangelisti, Matteo Tantari
Currently available medical therapies for endometriosis, acting through different endocrine pathways, have similar effects, such as interference with pituitary-gonadal stimulation, anovulation, induction of a steady hormonal state and reduction or suppression of the menstrual flow (3). Combined oral contraceptives (COCs) and progestins are the first-line medical therapies for endometriosis-related pain. Second-line therapy is represented by gonadotropin-releasing hormone agonists (GnRH-as). These therapies have no role in improving endometriosis-related infertility (5). In contrast, hormonal therapies typically interfere with ovulation and implantation and, thus, they should be interrupted in women desiring to conceive (4). Medical therapy can be administered to control pain after diagnosis of endometriosis, in patients with pain symptoms persisting after surgery and to prevent the postoperative recurrence of pain. Since hormonal therapies cause a temporary hypotrophy or atrophy of endometriotic lesions, it is obvious that endometriosis resumes its activity when the treatments are discontinued. Thus, the choice of treatment should be a balance of efficacy and adverse effects (3). Medical therapy alone is contraindicated in women with ovarian cysts with suspicion of malignancy, in those with intestinal endometriotic nodules suffering subocclusive or occlusive symptoms and in those with hydronephrosis caused by stenosis of the ureter.
Advanced Cell Therapy for Asherman's Syndrome
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Jordi Ventura, Xavier Santamaria
Moreover, other strategies, such as estrogen-based hormonal therapies, hyaluronic acid treatment, and intra-uterine device placement among others, have been proposed to prevent the recurrent formation of IUAs (31) after hysteroscopic removal. However, evidence is not clear for estrogen-based therapies and several points, such as optimal administration route and dose hormonal therapies, need to be addressed.
Endocrine Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
It has long been recognized that tumors derived from hormone-dependent tissues, such as the breast, endometrium, ovaries, testes, prostate, and various neuroendocrine tumors can themselves be dependent on the same hormones. This is unequivocally demonstrated by the remissions observed in premenopausal breast cancer following ovariectomy (surgical removal of the ovaries) and in prostatic cancer following orchiectomy (surgical removal of the testes). Thus, hormonal therapies play an important role in the treatment of these tumors. While not curative, they may provide excellent palliation of symptoms in some patients for many years, although, as with all tumor types and treatments, resistance eventually occurs and the tumors progress. However, manipulating the levels of hormones in the body can have a significant impact on some normal physiological systems in the body, thus leading to distinct side effects. For example, treating prostate cancer in men by reducing or completely ablating the levels of testosterone leads to feminization (e.g., weight gain and loss of libido).
Clinical efficacy and safety of trimonthly administration of goserelin acetate 10.8 mg in premenopausal Chinese females with symptomatic adenomyosis: a prospective cohort study
Published in Gynecological Endocrinology, 2023
Hao Sun, Ming Yuan, Xinyu Wang, Xue Jiao, Zangyu Pan, Hua Li, Linqing Yang, Liming Wang, Shihong Zhang, Qianhui Ren, Shumin Yan, Dong Li, Xinmei Zhang, Guoyun Wang
Our study has several potential limitations. First, the study design is open and the study length is relatively short. The hypoestrogenic side effects of GnRH-a limit its long-term treatment. In our study, after 12 weeks of treatment, almost half of the patients without conception plans in both groups chose to use LNG-IUS for long-term management. Several patients also used other hormonal therapies to consolidate treatment, such as combined oral contraceptives and progestins. Only a small proportion of patients with a uterine volume > 150 ml continued treatment with goserelin to 6 months. The patients’ different options for long-term management limited our study length, and a longer follow-up period would be required to clarify the long-term effects of GnRH-a after suspension of therapy. Second, the adverse event score is a subjective assessment method and most adverse events cannot be specifically measured. A more appropriate assessment method for measuring the severity of adverse events is lacking. Third, the adverse events are not stratified by age, which could allow for confounding effects due to common symptoms of menopause in older patients. We attempted to avoid this outcome by enrolling only patients without obvious symptoms of perimenopause. Finally, adenomyosis is clinically diagnosed primarily based on ultrasonographic features without histological evidence. Nonetheless, transvaginal ultrasonography has been proven accurate and reliable in diagnosing adenomyosis [26, 27].
Aromatase inhibitors in the pharmacotherapy of endometriosis
Published in Expert Opinion on Pharmacotherapy, 2023
Barbara Gardella, Edoardo Rispoli, Marianna Francesca Pasquali, Matteo Mauri, Valentina Musacchi, Mattia Dominoni
Adverse effects of AIs are mainly related to the hypoestrogenic state and are as follows: decrease in bone mineral density with risk of osteopenia and osteoporosis, hot flushes, vaginal dryness, and arthralgia. AIs have been associated also with cardiovascular toxicity, alteration of lipid profile, fatigue, forgetfulness, irregular bleedings, depression, weight gain, hair loss, decrease of libido, and sleep disturbances. The most relevant one is decrease in bone mineral density, which is the limiting factor in long-term, systemic treatment with AIs in patients with endometriosis in premenopausal women. After menopause, it is possible to control this adverse effect via the administration of bisphosphonates. Vitamin D and calcium supplements have failed to demonstrate any utility in preventing loss of bone mineral density in patients treated with AIs. The incidence of menopause-like adverse effects can be successfully limited by add-back hormonal therapies; however, knowledge on this matter is still limited.
Current approaches to overcome the side effects of GnRH analogs in the treatment of patients with uterine fibroids
Published in Expert Opinion on Drug Safety, 2022
Mohamed Ali, Mohamed Raslan, Michał Ciebiera, Kornelia Zaręba, Ayman Al-Hendy
Uterine fibroids are benign monoclonal neoplasms of the myometrium and represent the most common tumors in women worldwide. Unfortunately, there has been no long-term noninvasive treatment option that exists for these hormone-dependent tumors. Several reported risk factors are involved in UFs pathogenesis, the most important and frequent one being race, specifically, the African American race. Other risk factors include old age; obesity, vitamin D deficiency, pre-menopausal state; non-parity, family history of UFs and frequent consumption of soybean milk. Available hormonal therapies are used to control uterine bleeding and tumor growth based on regulation of estrogen and progesterone levels/effects. However, some of these hormonal therapies have the potential to interfere with endometrial development and implantation and therefore cannot be used while pursuing pregnancy. Initially, oral contraceptive pills were used to stop excessive uterine bleeding for short term considering their cost-effectiveness; however, their effect on tumor size was controversial and limits their long-term use. Similarly, levonorgestrel intrauterine devices have been used but limited with being expelled with tumors, especially submucosal ones.