Place des antagonistes dans le traitement de l’endométriose

Endometriosis is a common benign estrogen-dependent
chronic gynecological disorder characterized by the
presence of endometrial tissue outside the endometrial
cavity and is associated with pelvic pain, dysmenorrhea, dyspareunia,
and infertility (1, 2). The prevalence of endometriosis
is estimated to be 10% in women of reproductive age;
furthermore, the frequency in women with pain, infertility,
or both is estimated to be 35% to 50% (1). Current standard
medications for endometriosis-associated pain include
nonsteroidal anti-inflammatory drugs to treat pain, or combined
oral contraceptives, progestogens, danazol, and
gonadotropin-releasing hormone (GnRH) agonists as a hormonal
approach (3). Combined oral contraceptive medications
are not effective in all patients with endometriosis and
are associated with increased risk for thromboembolic events
(4). Progestin-only products provide effective relief from
endometriosis-associated pain, similar to GnRH agonists
and danazol, but may be associated with uterine bleeding
(5). Injectable GnRH agonist peptides such as leuprorelin are
effective for endometriosis-associated pain (4). However,
GnRH agonists induce a transient increase in the secretion
of gonadotropins, resulting in a temporary worsening of
symptoms (6). Furthermore, it may take 3 to 4 weeks before
therapeutic effects are observed.