Endometriosis
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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.

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Endometriosis l.jpg

ENDOMETRIOSIS

WHAT IS THE GENERAL PRACTICE APPROACH?


First a few questions l.jpg
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 l.jpg
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


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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


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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


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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


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Familial association

  • Relative Risk to siblings 2.3 overall

  • Relative Risk to sibs if severe endo 15


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Risk factors

  • Single/nulliparous

  • Early menarche

  • Non oral contraception

  • Non smoker shorter cycle/longer duration of flow

  • Dysplastic naevus syndrome, melanoma


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symptoms

  • 90% severe dysmenorrohoea

  • 70% chronic pelvic pain

  • 75% dyspareunia

  • 55% infertility



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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


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treatment of menstrual pain

Treatment level of evidence

Simple analgesics 1

Herbal remedies 1

alcohol 2

Antidepressants/anxiolytics 2

OCPs 1

NSAIDS 3


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ENDOMETRIOSIS PAIN

  • PSYCO-PHYSICAL TREATMENTS-ACCUPUNCTURE, MESSAGE, RELAXATION, TENS

  • EXERCISE

  • ANTI-OESTROGEN DRUGS

  • LAPAROSCOPY/ OPEN SURGERY


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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



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