Debilitating Pain of Endometriosis: Could Anti-Tumour Necrosis Factor Alpha Be a Saviour?

Author(s): Salma Sultana, Aiman Hassan, Iana Malasevskaia, Stacey E. Heindl

Backgrounds: Endometriosis is a chronic, debilitating gynecological disorder causing pelvic pain, infertility, and emotional despair. Endometrial tissue production is based on estrogen provided by the ovaries and, thus, conventional management focuses on suppression of ovarian function. Current drug regimens are used to control the condition by causing the hypoestrogenism state. While this lack of circulating estrogen levels contribute to a regression of the disorder, this hypoestrogenicity often produces many negative and undesirable side effects. These drawbacks of existing drug therapies such as vaginal atrophy, dryness, bone loss, abnormalities in the lipid profile show their shortcomings and the need to produce new endometriosis treatments. The latest treatment for the medical management of endometriosis, and its limitations, is discussed in this review. Potential target areas that may be an enticing alternative to them also analyzed the conventional therapies and include aromatase inhibitors, gonadotropin-releasing hormone (GnRH) agonist, and tumor necrosis factor (TNF)-α inhibitors.

Aim of the study: The objective of the present comprehensive review was to determine the potency and safety of Anti-TNF-α in pelvic pain due to endometriosis and patient satisfaction with treatment in women with symptomatic recurrent endometriosis. The aim was to identify reports of studies including patients with endometriosis undergoing advanced non-hormonal, hormonal, surgical treatment, and evaluation of the effect of treatment on pain, recurrence, and spread of the endometriosis in premenopausal women.

Methods: Medline, PubMed, and Cochrane systemic review databases were searched using keywords: endometriosis, pelvic pain, dysmenorrhea, GnRH, Anti-TNF α, infliximab. A MeSH search through PubMed was conducted using combinations of keywords like endometriosis, advanced medical treatment, combined oral contraceptives, progestins, GnRH agonists, TNF α, TNF α-blocker, infliximab, and etanercept. Besides, the “similar articles” feature in PubMed was used to scan for other papers. To extract more information, we searched google scholar, PMC, Embase to identify all studies, trials, reviews reporting treatment responses to various therapies for endometriosis and pelvic pain. All the studies conducted on the treatment of endometriosis from NSAIDs to surgical interventions have been considered for this review. All related publications have been manually searched, and no grey literature was included.

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