Conservative surgical treatment for symptomatic
endometriosis is frequently associated with only partial relief of
pelvic pain or its recurrence. Therefore, medical
therapy constitutes an important alternative or
complement to surgery. However, no available compound is cytoreductive, and suppression instead of elimination of implants is the only realistic objective of pharmacological intervention. Because this implies prolonged periods of treatments, only medications with a favourable safety/tolerability/efficacy/cost profile should be chosen. In the past few years, innumerable new drugs for
endometriosis, which would interfere with several hypothesized pathogenic mechanisms, have been studied and their use foreseen. However, robust evidence of in vivo safety and efficacy is lacking and, at the moment, the principal modality to interfere with
endometriosis metabolism is still hormonal manipulation. Regrettably, in spite of consistent demonstration of a major effect on
pain even in patients with deeply infiltrating lesions,
progestins are underestimated and dismissed in favour of more scientifically fashionable and up-to-the-minute alternatives. Moreover,
oral contraceptives (OCs) dramatically reduce the rate of post-operative
endometrioma recurrence and should now be considered an essential part of long-term therapeutic strategies in order to limit further damage to future fertility. Finally, women who have used OC for prolonged periods will be protected from an increased risk of
endometriosis-associated
ovarian cancer. To avoid the several subtle modalities for distorting facts and orientating opinions in favour of specific compounds,
progestins and monophasic OC used continuously are here proposed as the reference comparator in all future randomized controlled trials on medical treatment for
endometriosis.