PMID- 26363387
OWN - NLM
STAT- MEDLINE
DCOM- 20160118
LR  - 20220321
IS  - 1556-5653 (Electronic)
IS  - 0015-0282 (Linking)
VI  - 104
IP  - 4
DP  - 2015 Oct
TI  - Treatment of pain associated with deep endometriosis: alternatives and evidence.
PG  - 771-792
LID - S0015-0282(15)01877-4 [pii]
LID - 10.1016/j.fertnstert.2015.08.031 [doi]
AB  - Pain is the most evident clinical manifestation of deep infiltrating 
      endometriosis (DIE). Several hormonal and immunologic mechanisms are markedly 
      altered in DIE compared with superficial peritoneal and ovarian endometriosis, 
      and may explain its most aggressive behavior and the presence of severe pain 
      symptoms. Hormonal therapies, such as combined hormonal contraceptives and 
      progestogens, should be regarded as first-line treatment, as they are 
      efficacious, safe, and well tolerated. Gonadotropin-releasing hormone agonists 
      may be used in patients with symptoms persisting after the administration of 
      first-line therapies. Scanty literature is available for danazol treatment in 
      patients with DIE and, however, it has become less popular due to the high rates 
      of androgenic adverse events (AEs). The partial relief of pain that often is 
      achieved with available therapies and its recurrence after the suspension of the 
      treatment have brought to the development of new therapies (such as aromatase 
      inhibitors, oral GnRH antagonists) that are currently under investigation. 
      Surgical excision of DIE should be considered in patients with pain symptoms 
      persisting after first-line hormonal therapies. The benefits of surgery in terms 
      of pain improvement should be always balanced with the risk of intraoperative 
      complications and for this reason surgical cases should be referred to tertiary 
      centers for the treatment of DIE. A multidisciplinary approach is mandatory in 
      patients with DIE involving the bowel and/or the urinary tract.
CI  - Copyright (c) 2015 American Society for Reproductive Medicine. Published by 
      Elsevier Inc. All rights reserved.
FAU - Ferrero, Simone
AU  - Ferrero S
AD  - Unit of Obstetrics and Gynecology, San Martino Hospital and National Institute 
      for Cancer Research, University of Genoa, Genoa, Italy; Department of 
      Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child 
      Health, University of Genoa, Genoa, Italy. Electronic address: 
      simone.ferrero@unige.it.
FAU - Alessandri, Franco
AU  - Alessandri F
AD  - Unit of Obstetrics and Gynecology, San Martino Hospital and National Institute 
      for Cancer Research, University of Genoa, Genoa, Italy.
FAU - Racca, Annalisa
AU  - Racca A
AD  - Unit of Obstetrics and Gynecology, San Martino Hospital and National Institute 
      for Cancer Research, University of Genoa, Genoa, Italy; Department of 
      Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child 
      Health, University of Genoa, Genoa, Italy.
FAU - Leone Roberti Maggiore, Umberto
AU  - Leone Roberti Maggiore U
AD  - Unit of Obstetrics and Gynecology, San Martino Hospital and National Institute 
      for Cancer Research, University of Genoa, Genoa, Italy; Department of 
      Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child 
      Health, University of Genoa, Genoa, Italy.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20150910
PL  - United States
TA  - Fertil Steril
JT  - Fertility and sterility
JID - 0372772
RN  - 0 (Analgesics)
RN  - 0 (Hormone Antagonists)
RN  - 0 (Progestins)
RN  - 33515-09-2 (Gonadotropin-Releasing Hormone)
SB  - IM
MH  - Analgesics/therapeutic use
MH  - Endometriosis/*complications/therapy
MH  - Female
MH  - Gonadotropin-Releasing Hormone/antagonists & inhibitors
MH  - Hormone Antagonists/therapeutic use
MH  - Humans
MH  - Pain Management/*methods
MH  - Pelvic Pain/*etiology/*therapy
MH  - Progestins/therapeutic use
MH  - Severity of Illness Index
OTO - NOTNLM
OT  - Deep endometriosis
OT  - endometriosis
OT  - medical treatment
OT  - pain
OT  - surgery
EDAT- 2015/09/13 06:00
MHDA- 2016/01/19 06:00
CRDT- 2015/09/13 06:00
PHST- 2015/06/23 00:00 [received]
PHST- 2015/08/24 00:00 [revised]
PHST- 2015/08/25 00:00 [accepted]
PHST- 2015/09/13 06:00 [entrez]
PHST- 2015/09/13 06:00 [pubmed]
PHST- 2016/01/19 06:00 [medline]
AID - S0015-0282(15)01877-4 [pii]
AID - 10.1016/j.fertnstert.2015.08.031 [doi]
PST - ppublish
SO  - Fertil Steril. 2015 Oct;104(4):771-792. doi: 10.1016/j.fertnstert.2015.08.031. 
      Epub 2015 Sep 10.