抗孕激素
孕三烯酮是一种 19-去甲睾酮（雄激素）衍生物，具有抗孕激素活性。作为一种长效药物，其亦具有抗雌激素和抗性腺激素的活性。[47]Brown J, Kives S, Akhtar M. Progestagens and anti-progestagens for pain associated with endometriosis. Cochrane Database Syst Rev. 2012 Mar 14;(3):CD002122.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002122.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/22419284?tool=bestpractice.com[67]Bromham DR, Booker MW, Rose GL, et al. Updating the clinical experience in endometriosis - the European perspective. Br J Obstet Gynaecol. 1995 Oct;102 Suppl 12:12-6.http://www.ncbi.nlm.nih.gov/pubmed/7577849?tool=bestpractice.com 主要副作用为雄激素过高的相关症状（油性皮肤、不可逆的声音改变及痤疮）。这种药物目前在美国尚不可用。米非司酮可改善痛经及性交不适的症状，但还需进一步研究以确定其安全性及最佳用药剂量。[93]Fu J, Song H, Zhou M, et al. Progesterone receptor modulators for endometriosis. Cochrane Database Syst Rev. 2017 Jul 25;(7):CD009881.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD009881.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/28742263?tool=bestpractice.com
选择性孕激素受体调节剂（selective progesterone receptor modulator, SPRM）
在早期临床试验中，SPRM 可较对照组明显改善子宫内膜异位症相关疼痛。[94]Chwalisz K, Perez MC, Demanno D, et al. Selective progesterone receptor modulator development and use in the treatment of leiomyomata and endometriosis. Endocr Rev. 2005 May;26(3):423-38.http://edrv.endojournals.org/cgi/content/full/26/3/423http://www.ncbi.nlm.nih.gov/pubmed/15857972?tool=bestpractice.com[95]Kohler G, Faustmann TA, Gerlinger C, et al. A dose-ranging study to determine the efficacy and safety of 1, 2, and 4mg of dienogest daily for endometriosis. Int J Gynaecol Obstet. 2010 Jan;108(1):21-5.http://www.ncbi.nlm.nih.gov/pubmed/19819448?tool=bestpractice.com[60]Strowitzki T, Marr J, Gerlinger C, et al. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod. 2010 Mar;25(3):633-41.http://humrep.oxfordjournals.org/content/25/3/633.longhttp://www.ncbi.nlm.nih.gov/pubmed/20089522?tool=bestpractice.com 其作用机制是抑制子宫内膜的增殖作用，且不抑制雌激素的产生，从而避免了相关的血管舒缩症状和骨密度的降低。但阻断孕激素的作用可引起子宫内膜增生。
抗肿瘤坏死因子-α 疗法
目前还没有足够的证据推荐使用抗肿瘤坏死因子-α 药物缓解子宫内膜异位症女性的盆腔疼痛。[96]Lu D, Song H, Shi G. Anti-TNF-α treatment for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD008088.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008088.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23543560?tool=bestpractice.com
促性腺激素释放激素 (GnRH) 拮抗剂
噁拉戈利 (elagolix) 是一种口服非肽类 GnRH 拮抗剂，其对于卵巢的抑制呈剂量依赖性。[97]Carr B, Dmowski WP, O'Brien C, et al. Elagolix, an oral GnRH antagonist, versus subcutaneous depot medroxyprogesterone acetate for the treatment of endometriosis: effects on bone mineral density. Reprod Sci. 2014 Nov;21(11):1341-51.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212335/http://www.ncbi.nlm.nih.gov/pubmed/25249568?tool=bestpractice.com 两项应用噁拉戈利治疗子宫内膜异位症的 III 期临床试验发现，在六个月的治疗周期中，与安慰剂相比，噁拉戈利可显著减少痛经和非月经性盆腔疼痛。[98]Dun EC, Taylor HS. Elagolix: a promising oral GnRH antagonist for endometriosis-associated pain. Oncotarget. 2017 Nov 11;8(59):99219-20.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725085/http://www.ncbi.nlm.nih.gov/pubmed/29245894?tool=bestpractice.com 噁拉戈利导致的雌激素水平低的相关副作用包括潮热、血脂升高以及骨密度降低等。但是，这些副作用在注射用药时可能更加常见。[97]Carr B, Dmowski WP, O'Brien C, et al. Elagolix, an oral GnRH antagonist, versus subcutaneous depot medroxyprogesterone acetate for the treatment of endometriosis: effects on bone mineral density. Reprod Sci. 2014 Nov;21(11):1341-51.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212335/http://www.ncbi.nlm.nih.gov/pubmed/25249568?tool=bestpractice.com[98]Dun EC, Taylor HS. Elagolix: a promising oral GnRH antagonist for endometriosis-associated pain. Oncotarget. 2017 Nov 11;8(59):99219-20.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725085/http://www.ncbi.nlm.nih.gov/pubmed/29245894?tool=bestpractice.com美国食品药品监督管理局对于噁拉戈利的审批正在进行中。
辅助手术操作
阻断神经通路的辅助手术在相关妇科学文献中进行了广泛探讨，包括腹腔镜宫骶神经消融术或简称 LUNA（laparoscopic uterosacral nerve ablation；阻断附着于宫颈/子宫的神经束），腹腔镜骶前神经切除术或简称 PSN（pre-sacral neurectomy；切断营养盆腔的较大神经通路）。尽管部分特定人群中显示潜在收益，LUNA和PSN仍在研究阶段。[99]Proctor ML, Latthe PM, Farquhar CM, et al. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001896.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001896.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/16235288?tool=bestpractice.com[100]National Institute for Health and Care Excellence. Laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain. Oct 2007 [internet publication].https://www.nice.org.uk/guidance/ipg234 然而，最新的数据支持 PSN 用于治疗中央性盆腔疼痛。[101]Flower A, Liu JP, Lewith G, et al. Chinese herbal medicine for endometriosis. Cochrane Database Syst Rev. 2012 May 16;(5):CD006568.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006568.pub3/pdfhttp://www.ncbi.nlm.nih.gov/pubmed/22592712?tool=bestpractice.com
辅助药物
各种药物的副作用及疗效的局限性促使子宫内膜异位症患者寻求多种补充及替代药物。在一项 2016 年的 Cochrane 评价中，有限证据支持使用维生素 B1 和鱼油以及其他营养补充剂治疗原发性痛经，但由于缺乏研究来复制这些结局、样本量过小、证据质量较低以及缺乏标准化的给药方案，这些证据存在局限性。鉴于研究有限，目前尚无足够的证据支持这些补充剂的应用。[102]Pattanittum P, Kunyanone N, Brown J, et al. Dietary supplements for dysmenorrhoea. Cochrane Database Syst Rev. 2016 Mar 22;(3):CD002124.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002124.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/27000311?tool=bestpractice.com 另一项 Cochrane 评价发现腹腔镜术后给予中药治疗，可缓解子宫内膜异位症相关疼痛，其疗效与激素治疗类似。然而，在进一步研究之前，不推荐将补充医疗作为子宫内膜异位症的标准治疗。[102]Pattanittum P, Kunyanone N, Brown J, et al. Dietary supplements for dysmenorrhoea. Cochrane Database Syst Rev. 2016 Mar 22;(3):CD002124.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002124.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/27000311?tool=bestpractice.com[101]Flower A, Liu JP, Lewith G, et al. Chinese herbal medicine for endometriosis. Cochrane Database Syst Rev. 2012 May 16;(5):CD006568.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006568.pub3/pdfhttp://www.ncbi.nlm.nih.gov/pubmed/22592712?tool=bestpractice.com
