Editing Endometriosis (section)

===Hormonal medications===
{{See also|High-dose estrogen}}

* [[Hormonal birth control]] therapy: Birth control pills reduce the menstrual pain and recurrence rate for endometrioma following conservative surgery for endometriosis.<ref>{{cite journal | vauthors = Zorbas KA, Economopoulos KP, Vlahos NF | title = Continuous versus cyclic oral contraceptives for the treatment of endometriosis: a systematic review | journal = Archives of Gynecology and Obstetrics | volume = 292 | issue = 1 | pages = 37–43 | date = July 2015 | pmid = 25644508 | doi = 10.1007/s00404-015-3641-1 | s2cid = 23340983 }}</ref> A 2018 Cochrane systematic review found that there is insufficient evidence to make a judgement on the effectiveness of the combined oral contraceptive pill compared with placebo or other medical treatment for managing pain associated with endometriosis partly because of lack of included studies for data analysis (only two for COCP vs placebo).<ref name="Brown Crawford Datta Prentice p. ">{{cite journal | vauthors = Brown J, Crawford TJ, Datta S, Prentice A | title = Oral contraceptives for pain associated with endometriosis | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 5 | pages = CD001019 | date = May 2018 | pmid = 29786828 | pmc = 6494634 | doi = 10.1002/14651858.cd001019.pub3 | publisher = Wiley }}</ref>
* [[Progestogen]]s: Progesterone counteracts estrogen and inhibits the growth of the endometrium.<ref name="PatelElguero2014">{{cite journal | vauthors = Patel B, Elguero S, Thakore S, Dahoud W, Bedaiwy M, Mesiano S | title = Role of nuclear progesterone receptor isoforms in uterine pathophysiology | journal = Human Reproduction Update | volume = 21 | issue = 2 | pages = 155–73 | year = 2014 | pmid = 25406186 | pmc = 4366574 | doi = 10.1093/humupd/dmu056 }}</ref> [[Danazol]] and [[gestrinone]] are suppressive steroids with some androgenic activity.<ref name="AFFDiagnosisandTreat"/> Both agents inhibit the growth of endometriosis but their use has declined, due in part to [[masculinization|virilizing]] side effects such as [[hirsutism|excessive hair growth]] and [[voice changes]].<ref>{{cite web|url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/017557s033s039s040s041s042lbl.pdf|title=DANOCRINE : Brand of DANAZOL CAPSULES, USP|website=Accessdata.fda.gov|access-date=3 March 2022|archive-date=2 April 2021|archive-url=https://web.archive.org/web/20210402121305/https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/017557s033s039s040s041s042lbl.pdf|url-status=live}}</ref> There is tentative evidence based on cohort studies that dienogest and [[norethisterone acetate]] (NETA) may help patients with DIE in terms of pain.<ref name="DAlterio DAncona Raslan Tinelli 2021 pp. 88–94">{{cite journal | vauthors = D'Alterio MN, D'Ancona G, Raslan M, Tinelli R, Daniilidis A, Angioni S | title = Management Challenges of Deep Infiltrating Endometriosis | journal = International Journal of Fertility & Sterility | volume = 15 | issue = 2 | pages = 88–94 | date = April 2021 | pmid = 33687160 | pmc = 8052801 | doi = 10.22074/IJFS.2020.134689 }}</ref> There is tentative evidence based on a prospective study that vaginal danazol reduces pain in those affected by DIE.<ref name="DAlterio DAncona Raslan Tinelli 2021 pp. 88–94"/>
* [[Gonadotropin-releasing hormone modulator|Gonadotropin-releasing hormone (GnRH) modulator]]s: These drugs include [[GnRH agonist]]s such as [[leuprorelin]], and [[GnRH antagonist]]s such as [[elagolix]] and are thought to work by decreasing estrogen levels.<ref name="brown2010" /> A 2010 Cochrane review found that GnRH modulators were more effective for pain relief in endometriosis than no treatment or [[placebo]], but were not more effective than danazol or intrauterine progestogen, and had more side effects than danazol.<ref name="brown2010">{{cite journal | vauthors = Brown J, Pan A, Hart RJ | title = Gonadotrophin-releasing hormone analogues for pain associated with endometriosis | journal = The Cochrane Database of Systematic Reviews | issue = 12 | pages = CD008475 | date = December 2010 | volume = 2010 | pmid = 21154398 | pmc = 7388859 | doi = 10.1002/14651858.CD008475.pub2 }}</ref> A 2018 Swedish systematic review found that GnRH modulators had similar pain-relieving effects to gestagen but also decreased bone density.<ref name=":0" />
* [[Aromatase inhibitor]]s are medications that block the formation of estrogen and have become of interest for researchers who are treating endometriosis.<ref>{{cite journal | vauthors = Attar E, Bulun SE | title = Aromatase inhibitors: the next generation of therapeutics for endometriosis? | journal = Fertility and Sterility | volume = 85 | issue = 5 | pages = 1307–18 | date = May 2006 | pmid = 16647373 | doi = 10.1016/j.fertnstert.2005.09.064 | doi-access = free | title-link = doi }}</ref> Examples of aromatase inhibitors include [[anastrozole]] and [[letrozole]]. Evidence for aromatase inhibitors is confirmed by numerous controlled studies that show benefit in terms of pain control and quality of life when used in combination with gestagens or oral contraceptives, with fewer side effects when used in combination with oral contraceptives like norethisterone acetate.<ref name="Słopień Męczekalski 2016 pp. 43–47">{{cite journal | vauthors = Słopień R, Męczekalski B | title = Aromatase inhibitors in the treatment of endometriosis | journal = Przeglad Menopauzalny = Menopause Review | volume = 15 | issue = 1 | pages = 43–7 | date = March 2016 | pmid = 27095958 | pmc = 4828508 | doi = 10.5114/pm.2016.58773 | publisher = Termedia Sp. z.o.o. }}</ref> Despite multiple benefits, there are a lot of things to consider before using aromatase inhibitors for endometriosis, as it is common for them to induce functional cysts as an adverse effect. Moreover, dosages, treatment length, appropriate add-back therapies and mode of administration is still being investigated.<ref name="Garzon Laganà Barra Casarin 2020 pp. 1377–1388">{{cite journal | vauthors = Garzon S, Laganà AS, Barra F, Casarin J, Cromi A, Raffaelli R, Uccella S, Franchi M, Ghezzi F, Ferrero S | title = Aromatase inhibitors for the treatment of endometriosis: a systematic review about efficacy, safety and early clinical development | journal = Expert Opinion on Investigational Drugs | volume = 29 | issue = 12 | pages = 1377–1388 | date = December 2020 | pmid = 33096011 | doi = 10.1080/13543784.2020.1842356 | publisher = Informa UK Limited | s2cid = 225058751 }}</ref>
* Progesterone receptor modulators like [[mifepristone]] and [[gestrinone]] have the potential (based on only one [[randomized controlled trial]] each) to be used as a treatment to manage pain caused by endometriosis.<ref name="Fu Song Zhou Zhu p. ">{{cite journal | vauthors = Fu J, Song H, Zhou M, Zhu H, Wang Y, Chen H, Huang W | title = Progesterone receptor modulators for endometriosis | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 7 | pages = CD009881 | date = July 2017 | pmid = 28742263 | pmc = 6483151 | doi = 10.1002/14651858.cd009881.pub2 | publisher = Wiley }}</ref>