The DOI matches its Crossref record; 110 of the 112 references it cites were found in a registry or an index; 1 of the 72 sources its claims cite were checked for support.
“Waiting for Godot”: a commonsense approach to the medical treatment of endometriosis
Open accessAbstract
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.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This review argues that medical treatment for endometriosis should aim at long-term suppression rather than cure, and that progestins and continuous monophasic oral contraceptives (OCs) are effective, safe, inexpensive options that are underused. It proposes these as reference comparators in future randomized controlled trials and highlights postoperative OC use for preventing endometrioma and symptom recurrence.
Key findings
- No available drug is cytoreductive; suppression is the only realistic objective, so prolonged therapy is needed. In nine controlled trials identified from 1990–2010, progestins and OCs relieved pain and were generally not inferior to danazol, GnRH agonists, and aromatase inhibitors.
- Postoperative OC use dramatically reduced endometrioma recurrence in three controlled studies, with odds ratios from 0.04 (Takamura et al., 2009) to 0.32 (Seracchioli et al., 2010a). Two RCTs showed reduced dysmenorrhoea recurrence with postoperative progestin/OC versus expectant management (OR 0.14 and 0.32).
- Recurrence after conservative surgery is common: 10% at 1 year, 25% at 3 years, and 45% at 5 years (Evers et al., 1991); >20% at 2 years and 40–50% at 5 years (Guo, 2009); endometrioma recurrence reportedly 30–50% after 2–5 years.
- Costs are substantial: global endometriosis cost was $18.8–$22 billion per year based on 2002 US data; annual therapy costs ranged from €18 for low-dose norethisterone acetate to about €2100 for aromatase inhibitors or GnRH agonists, and about €4200 if combined.
Methods
- Narrative review/opinion article; no primary data. A MEDLINE search from January 1990 to July 2010 in English (MeSH terms: endometriosis, progestins, OCs, medical therapy) identified nine controlled trials comparing a progestin or OC with an alternative hormonal compound.
- A second MEDLINE search from January 2000 to July 2010 (MeSH terms: endometriosis, endometrioma, recurrence, OC, laparoscopy) identified three controlled studies on long-term postoperative OC use and endometrioma recurrence.
- The paper also cites RCTs on postoperative progestin/OC use for symptom recurrence; study quality was not assessed, and no meta-analysis was performed.
Limitations
- Stated: study quality was not assessed in the MEDLINE search; information on the cost of endometriosis to patients and society is limited.
- Evident: this is a narrative/opinion review with explicit advocacy for progestins and OCs, without systematic quality appraisal, risk-of-bias assessment, or meta-analysis; conclusions may be influenced by selected citation and interpretation of the literature.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
48 Not checked yet · 33 Own interpretation · 6 No basis given · 1 Partly supported · 1 Own method · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“whereas low-dose oral NETA is probably the best choice for rectovaginal lesions”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Life is now!
What the sources say
- Partly supportedcites Vercellini et al., 2005 sourceExperimental — accuracy not yet measured
The Abstract calls low-dose norethindrone acetate an effective, tolerable, inexpensive first-choice medical alternative to repeat surgery for symptomatic rectovaginal lesions in patients who do not seek conception. The claim's broader “best choice for rectovaginal lesions” omits those limits and suggests a preference over all treatments that the paper does not establish. (LLM, conf=0.88)
- Not checked yetcites Vercellini et al., 2009d
- Not checked yetcites Remorgida et al., 2007a
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
In the paper
“women who have used OC for prolonged periods will be protected from an increased risk of endometriosis-associated ovarian cancer”
- Also stated in: § Life is now! · hedged
“women who have used OC for prolonged periods might be reassured that they will be protected from an increase in risk of endometriosis-associated ovarian cancer (Missmer et al., 2004)”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Abstract
What the sources say
- Not checked yetcites Missmer et al., 2004 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Life is now! · hedged
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Abstract
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“oral contraceptives (OCs) dramatically reduce the rate of post-operative endometrioma recurrence”
- Also stated in: § Prevention of recurrence? Yes we can! · boosted
“A dramatic reduction in the risk of reappearance of endometriotic cysts in OC users was consistently observed independent of cyclic or continuous use, with odds ratios varying from 0.04 (Takamura et al., 2009) to 0.32 (Seracchioli et al., 2010a).”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Abstract
What the sources say
- Not checked yetcites Takamura et al., 2009
- Not checked yetcites Seracchioli et al., 2010a
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Prevention of recurrence? Yes we can! · boosted
None of the sources cited for this claim have been checked yet.
In the paper
“A decreased PR-B/PR-A ratio has been demonstrated not only in ectopic tissue (Attia et al., 2000), but also in eutopic endometrium of women with endometriosis (Igarashi et al., 2005), albeit not consistently (Bukulmez et al., 2008).”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Challenging conventional biologic wisdom
What the sources say
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“the induction of experimental disease in mice leads to a completely opposite hormonal receptor expression, as total endometrial PR and PR-B were shown to be increased, and PR-A decreased in animals with endometriosis”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Challenging conventional biologic wisdom
What the sources say
- Not checked yetcites Lee et al., 2009
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Numerous clinical studies and systematic reviews have consistently demonstrated that hormonal compounds with very dissimilar pharmacological profiles determine comparable pelvic pain reduction.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
What the sources say
- Not checked yetcites American College of Obstetricians and Gynecologysts, 2000
- Not checked yetcites Kennedy et al., 2005
- Not checked yetcites Royal College of Obstetricians and Gynaecologysts, 2006
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“and, most importantly, with potentially severe side effects”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“several of the compounds included in Table I are associated with uncertain or no efficacy, such as pentoxifylline (Lv et al., 2009) or anti-TNF-a (Lv et al., 2010)”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
What the sources say
- Not checked yetcites Lv et al., 2009
- Not checked yetcites Lv et al., 2010
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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- Probably not a substantial claim. 13
- The quote only partly states this claim. 1
- It may state two separate claims as one. 14
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, no available compound is cytoreductive, and suppression instead of elimination of implants is the only realistic objective of pharmacological intervention.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“generally well-tolerated”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Life is now!
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
In the paper
“After treatment discontinuation, symptoms recurred without significant between-group differences, demonstrating that also aromatase inhibitors are neither cytoreductive nor curative.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Pharmacological extravagance
What the sources say
- Not checked yetcites Ferrero et al., 2009b
boosted- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Disease control may result in an acceptable improvement of quality of life, only if also safety, tolerability and costs of medications are taken into adequate account.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The risk of major untoward effects may be acceptable in the above clinical context, but not in otherwise healthy women affected by a benign condition.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“there are also substantial economic implications if efficacy is overestimated and the medication over-utilized, given that usually new molecules are among the most costly drugs on the market”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Introduction
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: New molecules are usually among the most costly drugs on the market.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, again it is unclear if the increased expression of this cytochrome P-450 complex constitutes the very reason for survival and proliferation of regurgitated endometrial cells, or if it is the consequence of local inflammation”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Pharmacological extravagance
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Moreover, during the reproductive period, aromatase inhibitors stimulate ovarian function, as they reduce the hypothalamic-pituitary estrogen feedback, with consequent rise in GnRH secretion, elevations in FSH and LH, and augmented follicular development.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Pharmacological extravagance
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“for the present the therapeutic target is not endometriosis cytoreduction, but suppression, which implies the survival of ectopic implants independently of the drug type, dosage, and duration of use (Evers, 1987)”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > The unpalatable taste of medical therapies
What the sources say
- Not checked yetcites Evers, 1987 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: A compound with selective properties only against the ectopic endometrial cell has not yet been synthesized.
In the paper
“According to Evers et al. (1991), 10% of patients redeveloped signs and symptoms of endometriosis after a 1-year follow-up period, 25% after 3 years and 45% after 5 years.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Prevention of recurrence? Yes we can!
What the sources say
- Not checked yetcites Evers et al., 1991
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In both cases, subjective and metabolic untoward effects would considerably undermine safety and tolerability.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Life is now!
hedgeddirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Study quality was not assessed.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Life is now!
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In fact, prescribing medications for a few months has no clear rationale and exposes women to extenuating recurrences of symptoms and lesions and to the risk of repetitive surgery.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Life is now!
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Maintaining that progestins and OCs may be of a little value in the prevention of endometrioma recurrence and that the use of post-operative medications may cause unnecessary side effects and cost increase seems questionable in light of recent research findings.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
hedged- Asserted: passes — The authors put it forward as true.
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- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
In the paper
“which is substantially higher than the estimated costs of other chronic disorders, such as Crohn's disease ($865 million) and migraine ($13-17 billion; Rogers et al., 2009).”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Scientific glasnost
What the sources say
- Not checked yetcites Rogers et al., 2009
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“these medications are still addressed with scepticism and sometimes not even mentioned among effective therapeutic alternatives.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
plain- Asserted: passes — The authors put it forward as true.
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- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
In the paper
“Also DeCherney (1992) maintains that the endometriosis annual recurrence rate may be as high as 15% and that cumulative rates 40% after 3-5 years.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Prevention of recurrence? Yes we can!
What the sources say
- Not checked yetcites DeCherney, 1992
hedged- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“According to studies based on 2002 US data, the global cost of the disease (including analgesics, hormonal therapies, gynaecological consultations, hospital admissions, surgical procedures, days off-work and reduced productivity) varies between $18.8 and $22 billion per year (Gao et al., 2006;Simoens et al., 2007)”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Scientific glasnost
What the sources say
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Moreover, pain symptoms relapse exposes patients to repetitive suffering, frustration, multiple courses of medical therapy and risk of serial surgery.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Prevention of recurrence? Yes we can!
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Recently, Guo (2009) calculated that the disease relapse rate is higher than 20% at 2 years and 40 -50% at 5 years.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Prevention of recurrence? Yes we can!
What the sources say
- Not checked yetcites Guo, 2009
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The latest pills are generally the most expensive, but not necessarily the most cost-effective.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Scientific glasnost
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Not all women using progestins will be relieved from pain, not all will be satisfied with their treatment, not all will continue it and not all will avoid surgery.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
plain- Asserted: passes — The authors put it forward as true.
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- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“as the mechanism of action seems to be ovulation inhibition.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“should be informed in an unbiased manner, as any misinformation may expose many of them to repeated surgery and a decrease in the probability of conception.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“But at least two-thirds of them could substantially ameliorate their health-related quality of life, controlling the disease with marginal associated morbidity.”
§ 'Waiting for Godot' † : a commonsense approach to the medical treatment of endometriosis > Conclusions
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
The paper relies on this without support.
Definitive surgery for endometriosis is generally not accepted by patients wishing to preserve fertility.
“an option generally not accepted by patients wishing to preserve fertility”
The paper relies on this without support.
Publication of reports in peer-reviewed journals is the most important source of information on novel drugs for physicians who generally have limited clinical experience with the latest treatments.
“publication of reports in 'peer-reviewed' journals constitutes the most important source of information on novel drugs for physicians who generally have limited clinical experience with the latest treatments”
The paper relies on this without support.
New molecules are usually among the most costly drugs on the market.
“usually new molecules are among the most costly drugs on the market”
The paper relies on this without support.
A compound with selective properties only against the ectopic endometrial cell has not yet been synthesized.
“As a compound with selective properties only against the ectopic endometrial cell has not yet been synthesized”
The paper relies on this without support.
Medical therapies for endometriosis are not curative.
“given that medical therapies for endometriosis are not curative”
The paper relies on this without support.
Medical treatment for endometriosis does not influence reproductive performance of infertile women.
“Medical treatment for endometriosis does not influence reproductive performance of infertile women.”
The paper relies on this without support.
Dropouts are usually largely dissatisfied because of persisting pain or development of major side effects.
“In fact, dropouts are usually largely dissatisfied because of persisting pain or development of major side effects.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Finally, when hormonal treatments are to be continued for long periods, estrogen-progestins and progestins appear to be among the compounds that most favorably balance benefits, harms, and costs (30,31).”
From A stepped-care approach to symptomatic endometriosis management: A participatory research initiative (2018) · cites this paper as [31]
Citations
Cites
1 retracted
Gonadotrophin-releasing hormone analogues for pain associated with endometriosis
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“…in relieving pain, generally well-tolerated, and not inferior to danazol, GnRH agonists and aromatase inhibitors (Vercellini et al., 1993, 1996; Prentice et al., 2000, 2004; Cosson et al., 2002; Petta et al., 2005; Schlaff et al., 2006; Crosignani et al., 2006b; Davis et al., 2007; Selak et…”
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“Endometriosis is an estrogen-dependent chronic inflammatory disease (Giudice, 2010) that can be effectively cured by definitive surgery (Shakiba et al., 2008), an option generally not accepted by patients wishing to preserve fertility.”
BackgroundBulun, S. E. (2009) · New England Journal of Medicine · doi:10.1056/nejmra0804690 · Cited by 1,772
ESHRE guideline for the diagnosis and treatment of endometriosis
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“This is acknowledged in several guidelines on the treatment of endometriosis (American College of Obstetricians and Gynecologysts, 2000; Kennedy et al., 2005; Royal College of Obstetricians and Gynaecologysts, 2006; Practice Committee of the American Society for Reproductive Medicine, 2008; Society of Obstetricians an…”
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“This would explain why 9% of patients do not respond to progestin treatment (Guo, 2009). by guest on Septem ber 24, 2015 http://hum rep.oxfordjournals.org/ D ow nloaded from The expression of human progesterone receptor (PR) is controlled by two promoters that direct the synthesis of mRNA…”
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“…GnRH agonists and aromatase inhibitors (Vercellini et al., 1993, 1996; Prentice et al., 2000, 2004; Cosson et al., 2002; Petta et al., 2005; Schlaff et al., 2006; Crosignani et al., 2006b; Davis et al., 2007; Selak et al., 2007; Harada et al., 2009; Ferrero et al., 2009b; Strowitzki et al., 2010a).”
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“…not inferior to danazol, GnRH agonists and aromatase inhibitors (Vercellini et al., 1993, 1996; Prentice et al., 2000, 2004; Cosson et al., 2002; Petta et al., 2005; Schlaff et al., 2006; Crosignani et al., 2006b; Davis et al., 2007; Selak et al., 2007; Harada et al., 2009; Ferrero et al.,…”
BackgroundEndometriosis: cost estimates and methodological perspective
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“8 and $22 billion per year (Gao et al., 2006; Simoens et al., 2007), which is substantially higher than the estimated costs of other chronic disorders,”
BackgroundInfluentialPriorities for Endometriosis Research: Recommendations From an International Consensus Workshop
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Surgical Treatment of Endometriosis: A 7-Year Follow-up on the Requirement for Further Surgery
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“(Giudice, 2010) that can be effectively cured by definitive surgery (Shakiba et al., 2008), an option generally not accepted by patients wishing to preserve fertility.”
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Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis
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Guo, S., & Groothuis, P. G. (2018) · Human Reproduction Update · doi:10.1093/humupd/dmy020 · Cited by 93
“Drug research and development (R&D) in endometriosis/adenomyosis has been painfully slow (Guo, 2014), and the disappointment is unmistakable (Vercellini et al., 2011), which becomes painfully clear when looking at the three products that have been launched for the treatment of endometriosis-related symptoms since the…”
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“Patients invited to participate into the study were informed that medical treatments are effective in relieving pain symptoms caused by endometriosis but they are not curative, and that pain symptoms often recur to a degree similar to baseline when the treatments are discontinued [19].”
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MRI in the Diagnosis of Endometriosis and Related Diseases
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“The pathophysiology of endometriosis is not well understood; therefore, current treatment options for endometriosis are limited to manipulation of female sex steroid hormones.(5,6) These treatment options have significant side effects and are all contraindicated in women wishing to conceive.”
BackgroundA stepped-care approach to symptomatic endometriosis management: A participatory research initiative
Vercellini, P., Donati, A., Ottolini, F., Frassineti, A., Fiorini, J., Nebuloni, V., Frattaruolo, M. P., Roberto, A., Mosconi, P., & Somigliana, E. (2018) · Fertility and Sterility · doi:10.1016/j.fertnstert.2018.01.037 · Cited by 64
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“However, disease recurrence is observed in more than 50% of cases after treatment discontinuation [33].”
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“Finally, when hormonal treatments are to be continued for long periods, oestrogen-progestins and progestins appear to be among the compounds that most favourably balance benefits, harm and costs (Vercellini et al., 2011).”
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“Hormonal modulation, however induced, may control endometriosis but not cure it (Vercellini et al., 2011).”
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“Endometriosis is a pathological condition characterized by hormonal dysregulation, and it has been observed that pharmacological interventions targeting this homeostatic imbalance demonstrate efficacy in managing the symptoms of this disease [39].”
BackgroundMarkers of Adult Endometriosis Detectable in Adolescence
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Self-citationPullen, N., Birch, C. L., Douglas, G. J., Hussain, Q., Pruimboom-Brees, I., & Walley, R. J. (2011) · Human Reproduction Update · doi:10.1093/humupd/dmr030 · Cited by 42
“The recurrence rates after the withdrawal of the therapy however are high, and so far no beneficial effect on longer term fertility has been proved and the treatments are associated with considerable side effects, which limit prolonged exposure (Guo, 2009; Vercellini et al., 2011).”
BackgroundLack of Transparency of Clinical Trials on Endometriosis
Guo, S., & Evers, J. L. H. (2013) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e318291f299 · Cited by 40
Lin, D., Huang, Q., Wu, R., Dai, S., Huang, Z., Ren, L., Huang, S., & Chen, Q. (2018) · American Journal of Reproductive Immunology · doi:10.1111/aji.13074 · Cited by 40
Involvement of estrogen receptor-related receptors in human ovarian endometriosis.
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A Call for New Theories on the Pathogenesis and Pathophysiology of Endometriosis
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Self-citationGaravaglia, E., Pagliardini, L., Tandoi, I., Sigismondi, C., Viganò, P., Ferrari, S. M., & Candiani, M. (2015) · Gynecologic and Obstetric Investigation · doi:10.1159/000366443 · Cited by 40
Self-citationPlatelets induce endothelial–mesenchymal transition and subsequent fibrogenesis in endometriosis
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Endometriosis: What is the Influence of Immune Cells?
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“Regarding drug therapy, hormonal manipulation remains the main modality to limit the progression of endometriosis and effectively inhibit the growth of the lesion (Vercellini et al. 2011, 2014).”
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Management of endometriosis: Toward value-based, cost-effective, affordable care
Vercellini, P., Facchin, F., Buggio, L., Barbara, G., Berlanda, N., Frattaruolo, M. P., & Somigliana, E. (2018) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2017.07.011 · Cited by 36
“Indeed, the superiority of these costly and less safe compounds over OCs and progestins has not been consistently demonstrated.(80,81) The results of available studies comparing OCs and progestins with other drugs in women with symptomatic endometriosis are summarized in eTable 1 (online only, available at https://doi.”
BackgroundSelf-citationThe molecular connections between the cannabinoid system and endometriosis
Sanchez, A. M., Viganò, P., Mugione, A., Panina‐Bordignon, P., & Candiani, M. (2012) · Molecular Human Reproduction · doi:10.1093/molehr/gas037 · Cited by 35
“However, results with this target were less clinically promising than previously envisioned, mostly because of the need to use other compounds in association with aromatase inhibitors during treatment (Vercellini et al., 2011).”
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Burla, L., Kalaitzopoulos, D. R., Metzler, J. M., Scheiner, D., & Imesch, P. (2021) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2021.05.040 · Cited by 38
Anti-platelet therapy is efficacious in treating endometriosis induced in mouse
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Reduced hemopexin levels in peritoneal fluid of patients with endometriosis
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“Current treatments, mainly including hormonal therapy or surgery, often bring some side effects.(4,5) Therefore, the novel therapeutic strategies that do not disturb the normal menstrual cycle and fertility are necessary.”
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“The development of nonhormonal drugs has been painfully slow.(9,10) One defining feature of ectopic endometrium is cyclic bleeding.”
BackgroundCan Platelet Indices Be New Biomarkers for Severe Endometriosis?
Avcıoğlu, S. N., Altınkaya, S. Ö., Küçük, M., Sezer, S. D., & Yüksel, H. (2014) · ISRN Obstetrics and Gynecology · doi:10.1155/2014/713542 · Cited by 31
Targeting galectin‐1‐induced angiogenesis mitigates the severity of endometriosis
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Retreatment Rates Among Endometriosis Patients Undergoing Hysterectomy or Laparoscopy
Soliman, A. M., Du, E. X., Yang, H., Wu, E. Q., & Haley, J. C. (2017) · Journal of Women s Health · doi:10.1089/jwh.2016.6043 · Cited by 32
“14,24 The development of novel treatments, such as selective estrogen and progesterone receptor modulators, GnRH antagonists, vascular growth factor inhibitors, and immunomodulators, may provide enhanced treatment options, but are still years away from licensure.”
Gonadotrophin-releasing hormone analogues and endometriosis: current strategies and new insights
Hashim, H. A. (2012) · Gynecological Endocrinology · doi:10.3109/09513590.2011.650751 · Cited by 29
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Stratégies thérapeutiques des tumeurs ovariennes présumées bénignes
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Current Treatment of Endometrioma
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Endometriosis for the primary care physician
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Calagna, G., Perino, A., Chianetta, D., Vinti, D., Triolo, M. M., Rimi, C., Cucinella, G., & Agrusa, A. (2015) · Taiwanese Journal of Obstetrics and Gynecology · doi:10.1016/j.tjog.2014.03.011 · Cited by 26
Bourdel, N., Roman, H., Mage, G., & Canis, M. J. (2011) · Gynécologie Obstétrique & Fertilité · doi:10.1016/j.gyobfe.2011.07.051 · Cited by 23
Huang, Q., Liu, X., & Guo, S. (2021) · Reproductive Medicine and Biology · doi:10.1002/rmb2.12426 · Cited by 24
“In vitro and in vivo characterization of PF- 04418948, a novel, potent and selective prostaglandin EP(2) receptor antagonist.”
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“Progestogens and combined contraceptives are particularly recommended and, according to current evidence and gynecological society guidelines, the different hormone treatments are equally effective.(13-22) Treatment choice should be based on patient’s pregnancy desire and clinical characteristics, and location of endo…”
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An Interdisciplinary Approach to Endometriosis-associated Persistent Pelvic Pain
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“As a general approach, we use CHCs and progestins as first-line therapy because they are better tolerated and less costly (44-48).”
MethodTetramethylpyrazine Retards the Progression and Fibrogenesis of Endometriosis
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“1 3 of non-hormonal drugs for endometriosis so far has been painfully stagnant [9, 10], and the resultant disappointment is palpable [11].”
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Innovations in classical hormonal targets for endometriosis
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Management of women affected by endometriosis: Are we stepping forward?
Guardo, F. D., Shah, M., Cerana, M. C., Biondi, A., Karaman, E., Török, P., Yela, D. A., Giampaolino, P., Marín-Buck, A., & Laganà, A. S. (2019) · Journal of Endometriosis and Pelvic Pain Disorders · doi:10.1177/2284026519841520 · Cited by 19
Metadata
- Authors
- Vercellini, P., Crosignani, P., Somigliana, E., Vigano, P., Frattaruolo, M. P., & Fedele, L.
- Affiliations
- University of Milan (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Corresponding author
- Vercellini, P.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-11-11
- Volume
- 26
- Issue
- 1
- Pages
- 3-13
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2117571760
- Semantic Scholar
- 63311710c2bb2995a9c0e275757690da0a84e5e1
- Cited by
- 180
- References
- 112
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 7 · 2021: 9 · 2020: 9 · 2019: 8 · 2018: 15 · 2017: 16 · 2016: 13 · 2015: 18 · 2014: 9 · 2013: 25 · 2012: 18
- FWCI
- 23.24
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- Human Reproduction (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- endometriosis, progestins, oral contraceptives, hormonal manipulation, endometrioma recurrence, postoperative recurrence, endometriosis-associated ovarian cancer, deep infiltrating endometriosis, pelvic pain, drug safety and tolerability
- MeSH terms
- Contraceptives, Oral, Endometriosis, Female, Humans, Drugs, Investigational, Randomized Controlled Trials as Topic, Secondary Prevention, Drug-Related Side Effects and Adverse Reactions
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