Endometriosis: Unveiling the contemporary issues in diagnosis and treatment (original) (raw)
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Evaluation and treatment of endometriosis
American family physician, 2013
Endometriosis, which affects up to 10 percent of reproductive-aged women, is the presence of endometrial tissue outside of the uterine cavity. It is more common in women with pelvic pain or infertility (25 to 40 percent and 70 to 90 percent, respectively). Some women with endometriosis are asymptomatic, whereas others present with symptoms such as debilitating pelvic pain, dysmenorrhea, dyspareunia, and decreased fertility. Diagnosis of endometriosis in primary care is predominantly clinical. Initial treatment includes common agents used for primary dysmenorrhea, such as nonsteroidal anti-inflammatory drugs, combination estrogen/progestin contraceptives, or progestin-only contraceptives. There is some evidence that these agents are helpful and have few adverse effects. Referral to a gynecologist is necessary if symptoms persist or the patient is unable to become pregnant. Laparoscopy is commonly used to confirm the diagnosis before additional treatments are pursued. Further treatmen...
Management of women affected by endometriosis: Are we stepping forward?
Journal of Endometriosis and Pelvic Pain Disorders
Endometriosis is an estrogen-dependent chronic disease defined by the presence of endometrial-like tissue, glands and stroma in ectopic areas. Among all the pathogenic theories proposed to explain the origin of the disease, a pivotal role for immune, hormonal, and epigenetic disbalances have been hypothesized. Endometriosis affects up to 10%–15% of women in reproductive age and represents one of the most common gynecological causes of severe pelvic pain. The main symptoms reported by patients are dysmenorrhea and deep dyspareunia. Although the histological confirmation has been commonly considered mandatory, to date the possibility offered by the improvement in imagining techniques allows to make a proper diagnosis of the disease in most of the cases. Medical therapy represents only a symptomatic treatment and not the definitive solution. The aim of the hormonal therapy is to abolish the menstrual flow using progestin, oral contraceptives, and gonadotropin-releasing hormone agonists...
ADVANCES IN THE MANAGEMENT OF ENDOMETRIOSIS: CURRENT DIAGNOSTIC AND THERAPEUTIC APPROACHES (Atena Editora), 2023
This scientific article offers a comprehensive overview of endometriosis, covering diagnostic methods and available therapeutic options. The research methodology included a comprehensive search in three academic databases (Google Scholar, Scielo and PubMed) from 2004 to 2023, encompassing articles in English, Portuguese and Spanish. The search used relevant keywords and established inclusion criteria. The diagnosis of endometriosis involves an approach that takes into consideration, clinical evaluation, imaging tests, such as transvaginal ultrasound and magnetic resonance imaging, and analysis of the serum marker CA-125. Laparoscopy is usually necessary for a definitive diagnosis, although it is invasive. Endometriosis treatment is highly personalized, focusing on resolving pelvic pain and managing infertility when present. Therapeutic options include drug treatment, surgery and assisted reproduction treatments. The choice of treatment depends on several factors, such as the stage of the disease and other clinical factors. Drug treatment includes different hormonal approaches, but ovarian suppression alone is not recommended to improve fertility except in preparation for IVF. Surgical therapy ranges from less complex procedures to more extensive interventions, focusing on organ conservation. Conservative surgery is preferred as there is no direct correlation between the extent of the disease and the severity of symptoms. Lesion ablation and adhesiolysis can improve fertility, especially in mild to moderate cases. Therefore, it is concluded that the treatment of endometriosis requires a personalized approach, considering the symptoms, stage of the disease and the patient's reproductive goals, with the aim of providing pain relief and improving quality of life. Diagnosis and treatment must be carefully considered in each case.
Endometriosis: A Clinicopathological Study in a Tertiary Care Hospital
2020
Background Endometriosis (EM) is an estrogen-dependent disease characterized by the presence of endometrial gland and stroma outside the uterus. It is commonly seen in the reproductive age group and is a leading cause of infertility. Patients present with chronic pelvic pain, menstrual abnormalities, dyspareunia, or mass per abdomen. Surgical excision is the treatment of choice with postoperative medications and progesterone agents. Aims and Objectives This study aims at determining the distribution of EM in terms of age, parity, symptoms, site, morphological features. We also analyzed the management of EM in these cases. Methodology This is a retrospective study done in a tertiary care hospital in Mangalore, India. The case records of 77 histopathologically confirmed cases of EM during the 7 years between June 2012 and May 2019 were studied. Demographic profiles, parity, presenting complaints, site of the lesion, morphological features, treatment given, follow-up, and recurrence...
Prevalence, Surgical, and Medical Management of Patients with Endometriosis amongst Indian Women
2023
Objective: This study aims to determine the prevalence of endometriosis in women in South India, the epidemiological factors involved, and evaluate the symptomatic burden associated with it. Design: A large-scale Hospital-based study was conducted among women of reproductive age (16 to 44 years) in the state of Telangana between March 2018 and March 2023. A randomized multi-stage stratified sampling method was adopted and included 2,400 women who were screened using a validated structured questionnaire. Patients presenting with symptoms indicative of endometriosis underwent additional assessment using abdominal ultrasonography (AUS) and serum cancer antigen 125 (CA125) tests. For confirmation, laparoscopy was offered to the patients who consented. Patients who declined laparoscopy were given the option of undergoing magnetic resonance imaging (MRI) instead. Results: Among 2,400 women who participated, 60 women have been diagnosed with endometriosis during the 5-year study period. The prevalence of endometriosis was found to be 2.5%. The mean age of participants was 15.2 ± 3.5 years and the mean age at menarche was found to be 12.9 ± 1.1 years. Out of 60 participants diagnosed with endometriosis 30% (n = 18) experienced irregular menstrual cycles. Approximately 33.3% (n = 20) of the women reported experiencing Dysmenorrhea, with 28.4% (n = 17) complaining of dyspareunia. Among the cases with menstrual pain, exhibited ultrasound findings suggestive of endometriosis, with elevated CA125 levels observed in 45% (n = 27) of these cases. All 60 patients who consented to laparoscopic confirmation, exhibited positive histo-pathological evidence of endometriosis. The prevalence of endometriosis is found to be significant in women of reproductive age group and found to be associated with high rates of infertility in 15 (25%) patients. The results of this study showed that the prevalence of endometriosis is found to be 2.5% which is similar to the other studies reported. The severity of endometriosis during laparoscopy was assessed using the rAFS staging system, revealing rates of 55% and 45% for disease in Stages I & II, Stages III, & IV, respectively. Conclusion: Our study concludes that endometriosis predominantly affects women in the reproductive age group and is often associated with primary infertility. The laparoscopic findings are identified as a standard tool for both diagnosis and treatment of endometriosis.
Endometriosis: diagnosis and management
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2010
To improve the understanding of endometriosis and to provide evidence-based guidelines for the diagnosis and management of endometriosis. OUTCOMES evaluated include the impact of the medical and surgical management of endometriosis on women's experience of morbidity and infertility. Members of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of both location in Canada and type of practice, as well as subspecialty expertise along with general gynaecology background. The committee reviewed all available evidence in the English and French medical literature and available data from a survey of Canadian women. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC. This document provides a summary of up-to-date evidence regarding diagnosis, investigations, and medical and surgical management of endometrio...
Research Aspects of Endometriosis
Endometriosis, Advances and Controversies. Tulandi & Redwine (Eds), 2004
https://books.google.com.et/books?id=Q9ldvHVtWCUC /// The finding of endometriosis does not always mean that patients need treatment. Patients may have asymptomatic endometriosis. This has been found in 61% of patients undergoing surgery for myomata, 50% undergoing sterilization, and 25% having tubal sterilization reversal. In addition, 93% of postmenopausal patients with endometriosis are relatively asymptomatic, and only 39 (29%) of 136 postmenopausal patients with endometriosis had a clinically significant disease. No prospective randomized trials compare electrosurgical coagulation with sharp excision. But excision appears to be superior under certain circumstances. These circumstances include deep lesions, lesions close to vital organs, and lesions of uncertain pathology. Endometriosis research must consider the possibility that the problem is chronic pelvic pain and not endometriosis. Endometriosis may have been the initiating factor or a cofactor. However, endometriosis may play a minor role when chronic pelvic pain is present. Research studies should seek to make this differentiation.
Guidelines for diagnosis and treatment of endometriosis
2018
1 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano 2 Dipartimento di Ginecologia e Ostetricia, IRCCS San Raffaele, Milano 3 Università degli Studi di Palermo, Palermo 4 Dipartimento di Scienze Biomediche, Sperimentali e Cliniche Mario Serio, Università degli Studi di Firenze, Firenze 5 Ospedale Civile Avellino, Avellino 6 Endoscopica Malzoni, Center for Advanced Endoscopic Pelvic Surgery, Avellino 7 Dipartimento of Biomedicina and Prevenzione Clinica ostetrico e Ginecologica, Università di Roma “Tor Vergata”, Roma 8 Dipartimento di Scienze Chirurgiche. Università degli Studi di Cagliari 9 Ostetrica e Ginecologica, Dipartimento di Medicina Molecolare e dello Sviluppo, Università di Siena, Siena 10 Ospedale S. Anna, Torino 11 Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano 12 IRCCS San Martino IST Università di Genova, Genova 13 Ginecologia e Fisiopatologia della Riproduzione Umana, Università di Bologna, Bologna
Endometriosis: A Clinicopathological Study
2018
Background: Endometriosis is defined by the presence of endometrial like glands and stroma without the endometrium and myometrium. It is an estrogen dependent condition and affects 6-10% of females commonly during their reproductive age. Theories have evolved to explain the mechanism of development of this disease whose etiology is largely unknown. It affects a wide range of organs and could present with symptoms. Aims: The aim of this study is to document the pattern of endometriosis at the Jos University Teaching Hospital in relationship to patient’s age, anatomical distribution of lesion, and symptoms (especially infertility). Study Design: This is a hospital based retrospective and descriptive study. The major grouping for data were age, site, and symptoms. Place and Duration of Study: Department of Histopathology, Jos University Teaching Hospital, Jos, Plateau State in North-Central Nigeria between 1st August 2007, and 31st August 2017 Materials and Methods: We reviewed all con...