Is suppressing the ovulatory cycle enough?

In an international, multicenter survey of patients treated in tertiary care centers (n=931), it was reported that

7 out of 10

endometriosis patients experience unresolved pain despite management1

According to American College of Obstetricians and Gynecologists (ACOG) guidelines:
Persistent symptoms after first-line failure in patients with suspected endometriosis are one reason to move from initial treatment options and consider a confirmatory laparoscopy or other suppressive therapy.2

Stopping the menses to reduce dysmenorrhea may not be enough to comprehensively address endometriosis pain.

Endometriosis should be viewed as a chronic disease that requires a lifelong management plan according to the American Society for Reproductive Medicine (ASRM)3

Endometriosis treatment goals3:

  1. Maximize the use of medical treatment
  2. Avoid repeated surgical procedures

Endometriosis treatment approach2,3

Below is information from ACOG and ASRM to begin your patient assessment*

*Adapted from ACOG and ASRM. This is not intended to direct your management plan.

Therapeutic options for management of endometriosis pain2-11

Contraceptive therapies
GnRH antagonists
GnRH agonists
Synthetic steroids
Aromatase inhibitors

1. De Graaff AA, D’Hooghe TM, Dunselman GA, Dirksen CD, Hummelshoj L, WERF EndoCost Consortium, Simoens S. The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum Reprod. 2013;28(10):2677-2685. 2. American College of Obstetricians and Gynecologists. Practice bulletin no. 114: management of endometriosis. Obstet Gynecol. 2010;116(1):223-236. 3. Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril. 2014;101(4):927-935. 4. Kodaman PH. Current strategies for endometriosis management. Obstet Gynecol Clin North Am. 2015;42(1):87-101. 5. Ezzati M, Carr BR. Elagolix, a novel, orally bioavailable GnRH antagonist under investigation for the treatment of endometriosis-related pain. Womens Health (Lond). 2015;11(1):19-28. 6. Ng J, Chwalisz K, Carter DC, Klein CE. Dose-dependent suppression of gonadotropins and ovarian hormones by elagolix in healthy premenopausal women. J Clin Endocrinol Metab. 2017;102(5):1683-1691. 7. Struthers RS, Nicholls AJ, Grundy J, et al. Suppression of gonadotropins and estradiol in premenopausal women by oral administration of the nonpeptide gonadotropin-releasing hormone antagonist elagolix. J Clin Endocrinol Metab. 2009;94(2):545-551. 8. Knudtson J, McLaughlin JE. Female reproductive endocrinology. Merck Manuals website. Updated March 2019. Accessed June 10, 2019. 9. Danocrine [package insert]. Bridgewater, NJ: Sanofi-Aventis. US LLC; 2011. 10. Lupron Depot [package insert]. North Chicago, IL: AbbVie Inc; 2018. 11. Giudice LC. Clinical practice: endometriosis. N Engl J Med. 2010;362(25):2389-2398.

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