Professional Documents
Culture Documents
Endometriosis
Endometriosis
FIRST A FEW
QUESTIONS!
IS TREATMENT ALWAYS REQUIRED?
WHO NEEDS TREATMENT?
DOES ANY TREATMENT REALLY
WORK?
DOES TREATMENT IN YOUNG
WOMEN PREVENT INFERTILITY AND
PROGRESSION?
PREVALENCE
NOT PRECISELY KNOWN2-5%
20-40% OF WOMEN IN INFERTILE COUPLE
RELATIONSHIPS VS 5% OF FERTILE
WOMEN
BUT ALSO FOUND IN 6-43% OF WOMEN
UNDERGOING LAPAROSCOPIC
STERILIZATION
52% OF TEENAGES WITH CPP SYNDROME
Familial association
Relative Risk to siblings 2.3 overall
Relative Risk to sibs if severe endo
15
Risk factors
Single/nulliparous
Early menarche
Non oral contraception
Non smoker shorter cycle/longer
duration of flow
Dysplastic naevus syndrome,
melanoma
symptoms
90%
70%
75%
55%
severe dysmenorrohoea
chronic pelvic pain
dyspareunia
infertility
Infertility mechanisms
Adhesion Increased Cell
Defective
s
PGs
mediated folliculog
distorsion
gamete
enisis
inj
Chronic
Activated Increased LUFFS
salpingiti macroph prev. ABs
s
ag
Altered
tubal
motil
Impaired
Sperm
Early
Luteal
Treatment of pain
NSAIDS: all significantly better than
placebo, studies vary which one is
best
Naproxen >mefanemic acid>aspirin
Naproxen=ibuprofen
Naproxen only drug with significant
SEs
treatment of menstrual
pain
Treatment
level
evidence
Simple analgesics
Herbal remedies
alcohol
Antidepressants/anxiolytics
OCPs
NSAIDS
of
1
1
2
2
1
3
ENDOMETRIOSIS PAIN
PSYCO-PHYSICAL TREATMENTSACCUPUNCTURE, MESSAGE,
RELAXATION, TENS
EXERCISE
ANTI-OESTROGEN DRUGS
LAPAROSCOPY/ OPEN SURGERY
LIMITATIONS OF DRUG
THERAPY
ONLY SHRINKS SOME TYPES OF
META-ANALYSIS MIN/MILD
ENDOMETRIOSIS
NO
TREAT
DRUG
THERAPY
SURGERY
IVF
PREG
RATE
44%
235
41%
418
1- 5
65%
912
1-6
20
257
FOLLOWUP
0.5-3