gms | German Medical Science

Endometriosis is a benign chronic gynecological disease characterized by endometrial-like tissue localized and growing outside the uterine cavity. Those ectopic endometriotic lesions are underlying typical cycle-dependent changes which may lead to severe pelvic pain, dysmenorrhea and dyspareunia. The symptoms substantially impact the quality of life in those patients. Moreover, this disease is one of the most frequent causes of infertility.

The disease is usually suspected based on rather unspecific symptomatology. The diagnosis might be supported in some occasions by imaging modalities. However, the definitive diagnosis requires a visual inspection of the pelvis during a laparoscopy. This surgery is usually combined with removal of all accessible lesions. As a result of the invasive diagnostic procedure, the disease is usually diagnosed rather late. Following surgery, many patients will suffer from relapses which may require further – sometimes multiple - surgeries.

The still unenlightened etiology of the disease did not allow development of a causal treatment, so far. The pharmacotherapy incorporates analgesics (usually NSAIDs). However, there is inconclusive evidence for their effectiveness in managing endometriosis associated pain. A further mainstay of pharmacotherapy is hormonal treatment by oral contraceptives, progestins and GnRH analogues. They suppress the ovarian cycle and thereby the cycle-dependent proliferation, transformation and shedding of the ectopic endometriotic lesions. However, those treatments are often not efficacious enough in reducing symptoms or are not approved for long-term treatment.

Therefore, the development of new efficient drugs is of great importance. Several preclinical disease models are available but need further qualification by successful development programs. Substantial efforts were made to qualify clinical endpoints allowing quantitative evaluation of endometriosis associated symptoms and their impact on patient's life. Still the diagnostic paradigm is only allowing inclusion of patients with recurrent disease which represent an advanced disease stage.

The ultimate goal is to develop new pharmaceuticals sufficient for long-term therapy of endometriosis capable to reduce the invasive surgical interventions and to sustainably improve the physical, mental and social well-being of women suffering from endometriosis.