[Maintenance therapy for endometriosis]

Abstract

Endometriosis is one of the most common gynecological diseases and is frequently associated with pelvic pain and infertility. Surgical and endocrine therapies successfully suppress pelvic pain, but it often recurs after completion of treatment. To maintain relief from pelvic pain while minimizing hypoestrogenic side effects, several regimens are proposed. Oral contraceptives plus dienogest, a novel progestogen, or a gonadotropin-releasing hormone agonist with estrogen supplementation (add-back therapy) can be used in long-term administration. The relief from pelvic pain achieved with a gonadotropin-releasing hormone agonist can be sustained by long-term administration of a tapered dose of danazol or medium-to-low doses of oral contraceptives. Local treatment with the levonorgestrel-releasing intrauterine system is an option for long-term suppression of pelvic pain.