臨床婦人科産科76巻7号

2022年07月発行

今月の臨床 子宮内膜症の最新知識―この1冊で重要ポイントを網羅する 疼痛を主訴とする場合

子宮内膜症の疼痛に対する薬物療法の選択肢と効果の差

著者： 森泰輔¹

所属機関： ¹京都府立医科大学大学院医学研究科女性生涯医科学

ページ範囲：P.624 - P.629

●子宮内膜症患者の約90％が月経痛を訴え，病期が進行すると月経時以外にも腰痛，排便痛，性交痛を引き起こす．

●子宮内膜症に関連する疼痛に対しては，NSAIDsなどによる対症療法やOC/LEP製剤，プロゲスチン製剤，GnRHアゴニスト/アンタゴニスト製剤などによるホルモン療法が選択される．

●ホルモン療法をどのように選択すればよいか，その効果の差について概説する．

参考文献

1）日本産科婦人科学会（編）：子宮内膜症取扱い規約第2部診療編，3版．pp1-91，金原出版，2021

2）Harada T, et al : Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis : a placebo-controlled, double-blinded, randomized trial. Fertil Steril 90 : 1583-1588, 2008

3）Harada T, et al : Ethinylestradiol 20μg/drospirenone 3mg in a flexible extended regimen for the management of endometriosis-associated pelvic pain : a randomized controlled trial. Fertil Steril 108 : 798-805, 2017

4）Harada T, et al : Efficacy of cyclic and extended regimens of ethinylestradiol 0.02mg-levonorgestrel 0.09mg for dysmenorrhea : a placebo-controlled, double-blind, randomized trial. Reprod Med Biol 20 : 215-223, 2021

5）Harada T, et al : Dienogest is a as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis- randomized, double, multi-centre trial. Fertil Steril 91 : 675-681, 2009

6）Lan S, et al : Analysis of the levonorgestrel-releasing intrauterine system in women with endometriosis. J Int Med Res 41 : 548-558, 2013

7）Harada T, et al : Relugolix, an oral gonadotropin-releasing hormone receptor antagonist, reduces endometriosis-associated pain compared with leuprorelin in Japanese women : a phase 3, randomized, double-blind, noninferiority study. Fertil Steril 117 : 583-592, 2022

8）Vercellini P, et al : A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis. Fertil Steril 60 : 75-79, 1993

9）Guzick DS, et al : Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Fertil Steril 95 : 1568-1573, 2011

10）Strowitzki T, et al : Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis : a 24 week, randomized, multicenter, open-label trial. Hum Reprod 25 : 633-641, 2010

11）Vercellini P, et al : Cyproterone acetate versus a continuous monophasic oral contraceptive in the treatment of recurrent pelvic pain after conservative surgery for symptomatic endometriosis. Fertil Steril 77 : 52-61, 2002