Gynecological therapy summarizes the pharmacotherapy of diseases in women’s reproductive system.
Major indications are uterine fibroids as well as endometriosis, both of which affect a considerable fraction of women at different stages of their life.
Endometriosis is a painful disease. It is estimated that one in ten women in their reproductive years suffer from endometriosis. Major pain categories are pelvic pain, often menstrual pain (dysmenorrhea), pain associated with intercourse (dyspareunia), but also pain during bowel movements (dyschezia).
In endometriosis, cells of the uterine lining (endometrium) grow in areas outside the uterus. It is thought that during menstruation, endometrial cells may leave the uterus through the Fallopian tubes and settle on the peritoneal lining, most commonly on the ovaries, Fallopian tubes and the tissue lining the pelvis. The misplaced endometrial tissues react to the cyclic hormonal changes as they would do inside the uterus – with each cycle grow and thicken, break down and bleed. The surrounding tissue will react with inflammation, scaring and painful adhesions.
Endometriosis is a major cause of infertility. It is estimated that 30% of patients seeking help at a fertility clinic have endometriosis.
Though the socio-economic costs may be comparable to other chronic diseases, endometriosis has largely remained neglected in the past. At present, it is still diagnosed very late – between 5 and 10 years after first occurrence.
The backbone of pharmacotherapy are pain medications, and progestins (alone or combined with estrogens as OCs). The recent advent of oral GnRH inhibitors sparked more awareness for the indication. In order to increase tolerability for this class of compounds, newer products are combined with low doses of estrogen to reduce the estrogen-withdrawal symptoms.
The gold standard for definitive diagnosis is still the laparoscopic identification of endometriotic lesions. This is one of the reasons for the late confirmation of the disease.