1 / 24

ENDOMETRIOSIS

ENDOMETRIOSIS. WHAT IS THE GENERAL PRACTICE APPROACH?. 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?. I DON’T HAVE THE ANSWERS.

omer
Download Presentation

ENDOMETRIOSIS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ENDOMETRIOSIS WHAT IS THE GENERAL PRACTICE APPROACH?

  2. 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?

  3. I DON’T HAVE THE ANSWERS • ENDOMETRIOSIS PROGRESSES IN MOST CASES OF MODERATE AND SEVERE DISEASE • SPON REGRESSION CAN OCCUR IN UP TO 58% OF MILDER CASES • NATURAL HISTORY IS STILL UNCHARTED TO A LARGE EXTENT

  4. HOWEVER---- • MEDICAL TREATMENTS AND SURGERY FAIL TO ARREST DISEASE IN UP TO A THIRD • COMBINATIONS OF TREATMENTS HAVE ALSO FAILED TO CONTROL DISEASE FOR INDEFINITE PERIODS WHEN FOLLOWED UP • PREGNANCY HAS A VARIABLE EFFECT ON ENDOMETRIOSIS—PERSISTENCE, REGRESSION AND PROGRESSION

  5. AND ALSO--------- • ENDOMETRIOSIS MAY OCCUR IN THE EARLY MENOPAUSE, USUALLY IN ASSOCIATION WITH HRT • LAPAROSCOPIC ABLATION OF VISIBLE ENDO IN INFERTILE WOMEN IS ASSOC WITH SIGNIFICANTLY INCREASED FERTILITY RATES • THERE IS NO DATA REGARDING EARLY INTERVENTION WRT PREVENTION

  6. PREVALENCE • NOT PRECISELY KNOWN—2-5% • 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

  7. Familial association • Relative Risk to siblings 2.3 overall • Relative Risk to sibs if severe endo 15

  8. Risk factors • Single/nulliparous • Early menarche • Non oral contraception • Non smoker shorter cycle/longer duration of flow • Dysplastic naevus syndrome, melanoma

  9. symptoms • 90% severe dysmenorrohoea • 70% chronic pelvic pain • 75% dyspareunia • 55% infertility

  10. Infertility mechanisms

  11. 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

  12. treatment of menstrual pain Treatment level of evidence Simple analgesics 1 Herbal remedies 1 alcohol 2 Antidepressants/anxiolytics 2 OCPs 1 NSAIDS 3

  13. ENDOMETRIOSIS PAIN • PSYCO-PHYSICAL TREATMENTS-ACCUPUNCTURE, MESSAGE, RELAXATION, TENS • EXERCISE • ANTI-OESTROGEN DRUGS • LAPAROSCOPY/ OPEN SURGERY

  14. LIMITATIONS OF DRUG THERAPY • ONLY SHRINKS SOME TYPES OF ENDOMETRIOSIS WHICH ARE OESTROGEN SENSITIVE IE RED AND BLISTER APPEARANCE NOT BROWN, BLACK AND WHITE • SHRINKAGE NOT COMPLETE- USUALY LEAVES MICRO DISEASE • RESULTS FOR INFERTILITY TREATMENT NO BETTER THAN NO TREATMENT • DOES NOT DEAL WITH ADHESIONS

  15. META-ANALYSIS MIN/MILD ENDOMETRIOSIS

More Related