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Endometriosis is a devastating disease spoiling the quality of life, decreasing the productivity of a woman and dragging a huge amount of annual expenditure. Being a hyperestrogenic condition, progestin becomes a natural choice. Low dose progestin (norethisterone acetate 2.5mg/day) has been prescribed in many studies. Dinogest (a fourth generation progestin) is showing promising results in doses of 2mg. Aromatase inhibitors (Letrozole, Anastrozole) and GnRH analogues are also used either singly or in different combinations, though GnRH analogues in long-term cause more adverse effects and could not satisfy the patients. Long-term treatment with monophasic oral contraceptives pills (OCP) or progestins may prevent or interrupt the endometriosis domino effect. Mifepristone 50mg/day for 6 months could be a good therapeutic option. GnRH antagonist - Cetrorelix 3mg weekly for 8 weeks resulted in regression of the disease. Selective Progesterone Receptor Modulators (SPRMs) have effective results, though some cases showed adverse effect of endometrial hyperplasia. Estrogen receptor beta ligand (ERB-L) is an upcoming promising therapeutic option. In endometriosis and subfertility management initial ovarian suppression is not needed. World Endometriosis Society (WES) Montpellier Endometriosis Consensus statements highlighted many important points which everybody concerned with endometriosis face in day-to-day life. Recurrence could be due to proliferation of abdominal mesenchymal cells which are not steroid dependent, hence hypoestrogenism cannot stop them. Therapy against mesenchymal cells could be a good option to prevent recurrences. Up-regulation of endometrial microRNA -199a-5p leads to suppression of cell proliferation, motility and angiogenesis of these ectopic mesenchymal cells. Thus, this microRNA -199a-5p is a promising armamentarium in endometriosis management.
Keywords: Endometriosis, Norethisterone acetate, Letrozole, GnRH-analogue, Mesenchymal cells, MicroRNA