Traitement médicamenteux de l'endométriose (adénomyose exclue)

Abstract

Endometriosis is a common condition often underestimated because of a tricky clinical diagnosis. Most frequent clinical presentations (dysmenorrhoea, dyspareunia, chronic pelvic pain) are very evocative if increased during menstruations. Endometriosis can also be revealed by urinary (dysuria, pollakiuria) or digestive (dyschezia, menstrual proctorrhagias, transit dysfunction) symptoms. Non-steroid anti-inflammatory drugs can be used as first-line medical treatment for sole dysmenorrhoea when the patient does not need contraception. In teenagers or very young women, provided there is no contraindication, estroprogestative oral contraception can be considered as alternative treatment. When symptoms are more severe or noncyclic, progestins chosen in 17α-hydroxy- or 19-Nor-progesterone-derivatives should be the first choice regarding their effectiveness, their low cost and their long-term good tolerance. GnRH agonists should only be considered when adequate pain relief is not obtained from the other treatment options or, for some authors, as a pre-operative therapy. For long-term treatment by GnRH agonist, hormone therapy should be associated to limit treatment side effects.