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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

ENDOMETRIOSIS

WHAT IS THE GENERAL PRACTICE APPROACH?

first a few questions
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
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
however
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
and also
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
prevalence
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
familial association
Familial association
  • Relative Risk to siblings 2.3 overall
  • Relative Risk to sibs if severe endo 15
risk factors
Risk factors
  • Single/nulliparous
  • Early menarche
  • Non oral contraception
  • Non smoker shorter cycle/longer duration of flow
  • Dysplastic naevus syndrome, melanoma
symptoms
symptoms
  • 90% severe dysmenorrohoea
  • 70% chronic pelvic pain
  • 75% dyspareunia
  • 55% infertility
treatment of pain
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 of menstrual pain

Treatment level of evidence

Simple analgesics 1

Herbal remedies 1

alcohol 2

Antidepressants/anxiolytics 2

OCPs 1

NSAIDS 3

endometriosis pain
ENDOMETRIOSIS PAIN
  • PSYCO-PHYSICAL TREATMENTS-ACCUPUNCTURE, MESSAGE, RELAXATION, TENS
  • EXERCISE
  • ANTI-OESTROGEN DRUGS
  • LAPAROSCOPY/ OPEN SURGERY
limitations of drug therapy
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
ad