**7. References**


Endometriosis is a multifactorial disorder including retrograde menstruation, immune tolerance, adhesion, transplantation and proliferation modulated by abnormal inflammatory cytokines profile in peritoneal fluid. Future studies are necessary to focus on the whole

The current treatments mainly focus on inhibiting estrogen and its receptors which are not useful for every patient with endometriosis because estrogen is only one factor in the development of endometriosis. The signaling pathway is essential and makes it possible to develop an effective medication which could not only decrease estrogen level but also inhibit inflammation cytokines, ROS and angiogenesis. On the other hand, complete understanding of pathogenesis of endometriosis such as cytokines could provide a new way to diagnose and even to divide the disease into different stages according to pathophysiolocal characteristics, which makes the treatment individual and personal.

What's more, prevention of endometriosis after surgery is also very important. The current medicines used for prevention of recurrence are not very effective and have various side effects. The understanding of pathogenesis of early endometriosis may produce a better therapy to prevent recurrence. Ultimately, more clinical and basic researches should be

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**27** 

*Iran* 

Elham Pourmatroud

**Medical Treatment in Endometriosis** 

Two important targets from medical treatment are: pain control and suppression of disease progress. Most of the time, the effectiveness is temporary and lasted while these drugs have been used, which is expected from the nature of endometriosis disease .Of course, there are some debts about the usefulness of pain relief agents, because 30-50% of patients feel better

It must to keep in mind that those common administrated drugs couldn't help to restore the fertility potentials and in fact during their usage pregnancy cannot or should not be happened, regarding to inhibition of ovulation or teratogenic effects; of course by their administration with remission of disease (suppress the growth and activity of previous endometriotic implants) and reducing the chance of new peritoneal seeding, fertility may be

Non hormonal therapeutic options, mainly work on inflammatory and immunologic aspect of endometriosis and hormonal attempts basically deprived endometriotic implants from

With attention to inflammatory nature of endometriosis, for decades non- steroidal antiinflammatory agents (NSAIDs) such as naproxen and ibuprofen have been administrated for pain control, in endometriosis. These drugs have been reduced prostaglandins (PGs) production, the main stimulator factor in peritoneal nerves and decrease the nociceptor input messenger from the peritoneal endometriotic implants into central nervous system. Their gastrointestinal upsets and inhibition of ovulation (Duffy &Stouffer,2002) against low cost and easy availability, always puts NSAIDs in a challenging situation; rather than, new NSAIDs as a selective cyclooxygenase (COX)-2 inhibitors like celecoxib without any effect on PG pathway, could induce apoptosis in endometriotic implants (Seo etal,2010). However

preserved better; but at the end for achieving pregnancy other ways should be used.

Medical therapeutic drugs divided in two categories:

a. Non hormonal medical therapy. b. Hormonal medical therapy.

their nutritive substance: estrogen.

**2. Non hormonal medical therapy** 

**2.1 Non-steroidal anti- inflammatory agents** 

**1. Introduction** 

with placebo administration.

*Ahvaz Jundishapur University of Medical Science (AJUMS),* 

