The goal of my lecture today is to give my opinion on endometriosis and give you an overview of all the medical, surgical, and combined therapy with the overview of the literature. The objectives of medical, surgical, and combined therapy are to understand all of the available treatment options and to know the aspirations of individual women. At the present time there are three options - medical, surgical, and combined medical and surgical therapy. Many, many medical therapies have been proposed, and if you look at the literature in 1998, you can use Danazol, progestogens, gestrinone, contraceptives, analgesics, and GnRH agonists, and in the future other molecules like GnRH antagonists, inhibitors of aromatase, and the new anti-oestrogens will be on clinical trial.
Hypoestrogenic agents are mixtures of old and new agents.
First, we have the progestogens, which are related to testosterone like norethindrone, dienogest, and gestagen, and the second subgroup is related to progesterone-like acetate of medroxyprogesterone and may just well be dydrogesterone. It causes initial breakdown of endometriotic tissue, leading to atrophy. It reduces the endometriotic implants and relief of the symptoms, but here there is also no proven effect on fertility and prevention of recurrence. The side effects are the same side effects of the progestogenic agents - weight gain, mood changes, breakthrough bleeding, fluid retention, and possibly an adverse effect on lipids. It could be that in some instances there is a delayed cycle recovery, with continued amenorrhoea and anovulation.