Advancing Non-Invasive Treatment Options for Endometriosis

Endometriosis is one of the most common gynecologic disorders in the United States, affecting an estimated 1 in 10 women of reproductive age.¹ Although their symptoms are not visible on the outside, women with endometriosis can suffer physically, emotionally and financially.^1,2,3 Recent data suggest that costs associated with endometriosis can be significant to individuals and the health care system, especially if surgery is required.³

Women with endometriosis can suffer up to 6 to 10 years and visit multiple physicians before receiving a proper diagnosis.^4,5 Symptoms, such as daily menstrual pain, nonmenstrual pelvic pain, and pain with intercourse,¹ can be debilitating and can impact day-to-day activities of women’s lives.² In a regional United States survey of 107 patients with endometriosis, 85% of respondents reported reduced quality of their work and more than half reported their sexual relationships being affected because of their symptoms.⁶

Unresolved symptoms associated with endometriosis can also result in a substantial financial burden to patients and increased health care costs.³

Current nonsurgical treatment options for endometriosis are limited and there have been few treatment advances in decades.⁷

Treatment for endometriosis must be individualized and both medical and surgical treatments can be effective.⁸ Professional society guidelines recommend maximizing medical management to avoid repeat surgeries.⁸ The American College of Obstetricians and Gynecologists guidelines, for example, recommend the use of a variety of medical options as initial treatment for women with endometriosis-related pain.⁹ This recommendation is particularly relevant if symptoms persist after initial treatment of endometriosis-associated pain.⁹

Medical options can include oral contraceptives, pain medications (ie, nonsteroidal anti-inflammatory drugs), hormonal therapies, and gonadotropin-releasing hormone (GnRH) agonists, some of which are not specifically indicated to treat endometriosis.^10,11 Women are in need of additional medical management treatment options that could provide symptom relief. Investigations of new treatments are looking at different mechanisms of action, including targeted treatment options that suppress ovarian sex hormones, follicular growth, and ovulation.¹²

For example, GnRH antagonists are beginning to be introduced to the treatment landscape for endometriosis. GnRH antagonists work by inhibiting endogenous GnRH signaling by binding competitively to GnRH receptors in the pituitary gland.¹² Administration results in dose-dependent suppression of luteinizing hormone and follicle-stimulating hormone, leading to decreased blood concentrations of ovarian sex hormones, estradiol and progesterone. ¹² Recovery of normal hormone production can be reversible following the last dose. ^11,12 The first oral GnRH antagonist specifically developed for women with moderate to severe endometriosis pain was approved by the US Food and Drug Administration in July 2018.¹²

As we look to the future, continued research and collaboration among industry, scientists and academia for additional non-invasive treatment options is needed to reduce the personal and financial burdens of endometriosis and ultimately help to improve the lives of the millions of women impacted by this chronic and painful disease.^1,2,3,13

References:

1. The American College of Obstetricians and Gynecologists (2018). Frequently Asked Questions: Endometriosis. https://www.acog.org/Patients/FAQs/Endometriosis.
2. Fourquet J, et al. Quantification of the Impact of Endometriosis Symptoms on Health-Related Quality of Life and Work Productivity. Fertil Steril. 2011 Jul;96(1):107-12.
3. Soliman AM, et al. Incremental Direct and Indirect Cost Burden Attributed to Endometriosis Surgeries in the United States. Fertil Steril. 2017 May;107(5):1181-1190.e2.
4. Giudice LC. Clinical Practice. Endometriosis. N Engl J Med. 2010 Jun 24;362(25):2389-98.
5. Nnoaham KE, et al. Impact of Endometriosis on Quality of Life and Work Productivity: A Multicenter Study Across Ten Countries. Fertil Steril. 2011 Aug;96(2):366-373.e8.
6. Fourquet J, et al. Patients’ Report on How Endometriosis Affects Health, Work, and Daily Life. Fertil Steril. 2010 May 1; 93(7): 2424—2428.
7. Kodaman PH. Current Strategies for Endometriosis Management. Obstet Gynecol Clin North Am. 2015 Mar;42(1):87-101.
8. The Practice Committee of the American Society for Reproductive Medicine. Treatment Of Pelvic Pain Associated With Endometriosis: A Committee Opinion. Fertil Steril. 2014 Apr;101(4):927-35.
9. Armstrong C. ACOG Updates Guideline on Diagnosis and Treatment of Endometriosis. Am Fam Physician. 2011 Jan 1;83(1):84-85.
10. Quaas AM, et al. On-Label And Off-Label Drug Use In The Treatment Of Endometriosis. Fertil Steril. 2015 Mar;103(3):612-25.
11. Orilissa (elagolix) [Package Insert]. North Chicago, Ill.: AbbVie Inc.
12. Mayo Clinic (2018). Endometriosis. https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661.
13. Fuldeore MJ, et al. Prevalence and Symptomatic Burden of Diagnosed Endometriosis in the United States: National Estimates from a Cross-Sectional Survey of 59,411 Women. Gynecol Obstet Invest. 2017;82(5):453-461.