![]() ![]() The main mechanisms involved in the ectopic location of endometrial cells include retrograde menstruation, vascular and lymphatic spread and/or metaplasia/stem cells. The pathophysiology of endometriosis is still a matter of investigation, but endocrine and inflammatory backgrounds are well characterized, recognizing an estrogen-dependency and a progesterone-resistance. However, the true prevalence is uncertain, because estimates vary widely among population samples and diagnostic approaches. The prevalence ranges between 2 and 10% of women in reproductive age, 30–50% among infertile women, and 5 to 21% among women with severe pelvic pain. This review aims to provide a comprehensive state-of-the-art on the current and future hormonal treatments for endometriosis, exploring the endocrine background of the disease.Įndometriosis is a chronic disease characterized by the presence of endometrium-like tissue outside the uterine cavity, affecting women of reproductive age with pelvic pain and infertility. Nowadays, all these hormonal drugs are considered the first-line treatment for women with endometriosis to improve their symptoms, to postpone surgery or to prevent post-surgical disease recurrence. Clinical trials are currently going on selective progesterone receptor modulators, selective estrogen receptor modulators and aromatase inhibitors. Combined oral contraceptives are also used for reducing endometriosis symptoms by inhibiting ovarian function. Progestins are mostly used for long term treatments (dienogest, NETA, MPA) and act on multiple sites of action. GnRH agonists and antagonists are effective on endometriosis by acting on pituitary-ovarian function. The hormonal treatment of endometriosis aims to block of menstruation through an inhibition of hypothalamus-pituitary-ovary axis or by causing a pseudodecidualization with consequent amenorrhea, impairing the progression of endometriotic implants. Endocrine and inflammatory changes explain pain and infertility, and the systemic comorbidities described in these patients, such as autoimmune (thyroiditis, arthritis, allergies), inflammatory (gastrointestinal/urinary diseases) and mental health disorders. Endometriotic cells express AMH, TGF-related growth factors (inhibin, activin, follistatin) CRH and stress related peptides. Estrogen-dependency and progesterone-resistance are the key events which cause the ectopic implantation of endometrial cells, decreasing apoptosis and increasing oxidative stress, inflammation and neuroangiogenesis. Hormonal drugs are currently the most used for the medical treatment and are based on the endocrine pathogenetic aspects. It is a chronic disease and requires a long term management. Endometriosis is a benign uterine disorder characterized by menstrual pain and infertility, deeply affecting women’s health. ![]()
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