Endometriosis Overview

Contents 

OVERVIEW
   
  • An estrogen-dependent disease wherein endometrial-like tissue is found outside the uterus inducing a chronic inflammatory response 
    •  Pelvic organs (esp ovaries) & peritoneum are frequently affected
  • Main clinical features include chronic pelvic pain, dyspareunia, & infertility
    • However, 2-22% of patients w/ endometriosis may be asymptomatic

 

Refer to Symptoms for more information

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DIAGNOSIS

   

  • Diagnosis of endometriosis is made after taking the patient's history & doing physical examination
    • Laboratory tests, laparoscopy, & imaging studies are performed as well to confirm diagnosis

 

Refer to Diagnosis for more information

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TREATMENT

   

  • Management of endometriosis includes medical therapy w/ first-line agents oral contraceptives & progestins
    • Second-line agents include Danazol, gonadotropin-releasing hormone (GnRH) agonists, Levonorgestrel intrauterine system, & aromatase inhibitors
    • Supportive therapy w/ nonsteroidal anti-inflammatory drugs (NSAIDs) may be given to provide pain relief
  • Surgery should only be done in women w/ endometriosis-related pain after medical treatment has failed
  • Combined medical/surgical therapy is medical therapy given before &/or after surgery

 

Refer to Treatment for more information on Pharmacological Therapy & Surgery

 

Below is the overview of disease management of Endometriosis:

 

overview of management of endometriosis Endometriosis1

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follow-up of endometriosis Endometriosis2.png

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Endometriosis Symptomsâ–¶

Version: 18 June 2015

 

Guideline References:

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  2. American Society for Reproductive Medicine. Endometriosis. A guide for patients. http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/endometriosis.pdf. 2012. Accessed 25 Apr 2013.
  3. Attaran M, Falcone T, Goldberg J. Endometriosis: still tough to diagnose and treat. Cleve Clin J Med. 2002 Aug;69(8):647-653. http://www.ncbi.nlm.nih.gov/pubmed/?term=12184473. PMID: 12184473
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  8. College National des Gynecologues et Obstetriciens Francais. CNGOF guidelines for the management of endometriosis. http://www.cngof.asso.fr/D_TELE/RPC_endometriose_en_BM.pdf. Nov 2006.
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  11. ESHRE Endometriosis Guideline Development Group. Management of women with endometriosis. Guideline of the European Society of Human Reproduction and Embryology [Draft version]. http://www.eshre.eu/binarydata.aspx?type=doc&sessionId=dhxqnrv5jhqpiw45ttwpuxup/ESHRE_ENDOMETRIOSIS_GUIDELINE_Draft_version_for_review.pdf. Apr 2013. Accessed 25 Apr 2013.
  12. European Society of Human Reproduction and Embryology. The ESHRE guideline for the diagnosis and treatment of endometriosis. http://guidelines.endometriosis.org/recommendations.html. Jun 2007.
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  17. Kocakoc E, Bhatt S, Droga VS. Endometriosis. Ultrasound Clin. 2008;3:399-414
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  20. Ling FW. Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstet Gynecol. 1999 Jan;93(1):51-58. PMID: 9916956
  21. Lobo RA. Endometriosis: etiology, pathology, diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gerhenson DM. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby, Elsevier; 2007
  22. Mishell D, Stenchever M, Droegemuller W, Herbst A. Endometriosis and adenomyosis. In: Stenchever M. Comprehensive Gynecology. 4th ed. St. Louis: Mosby; 2001
  23. Mol BW, Bayram N, Lijmer JG, et al. The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis. Fertil Steril. 1998 Dec;70(6):1101-1108. PMID: 9848302
  24. Moore J, Kennedy S, Prentice A. Modern combined oral contraceptives for pain associated with endometriosis (Cochrane Review). The Cochrane Library, Issue 2. Chichester, UK: John Wiley and Sons, Ltd; 2004
  25. Mounsey AL, Wilgus A, Slawson DC. Diagnosis and management of endometriosis. Am Fam Physician. 2006 Aug;74(4):594-600. PMID: 16939179
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  27. National Institute for Health and Care Excellence. Fertility. Assessment and treatment for people with fertility problems. NICE. http://www.nice.org.uk/nicemedia/live/14078/62769/62769.pdf. Feb 2013. Accessed 25 Apr 2013.
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  29. Practice Committee of the American Society for Reproductive Medicine. Endometriosis & infertility; a committee opinion. Fertil Steril. 2012 Sep;98(3):591-598. PMID: 22704630
  30. Prentice A, Deary AJ, Goldbeck-Wood S. Gonadotropin-releasing hormone analogues for pain associated with endometriosis (Cochrane Review). The Cochrane Library, Issue 2. Chichester, UK: John Wiley and Sons, Ltd; 2004.
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  32. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997 May;67(5):817-821. http://www.ncbi.nlm.nih.gov/pubmed/?term=9130884. PMID: 9130884
  33. Royal College of Obstetricians and Gynaecologists. The investigation and management of endometriosis. Green-top Guideline No. 24. http://www.pelvicpain.org.uk/uploads/documents/InvestigationEndometriosis2006%5B-guidelines.pdf. 2006.
  34. Selak V, Farquhar C, Prentice A. Danazol for pelvic pain associated with endometriosis (Cochrane review). The Cochrane Library, Issue 2. Chichester, UK: John Wiley and Sons, Ltd; 2004
  35. Society of Obstetricians and Gynaecologists of Canada. Endometriosis: diagnosis and management. Journal of Obstetrics and Gynaecology Canada. 2010;32(7):S1-S32. http://www.sogc.org/guidelines/documents/gui244CPG1007E.pdf. PMID: 21545757
  36. Surrey ES, Hornstein MD. Prolonged GnRH agonist and add-back therapy for symptomatic endometriosis: long-term follow-up. Part 1. Obstet Gynecol. 2002 May;99(5)(Pt 1):709-719. PMID: 11978277
  37. Taskin O, Yalcinoglu A, Kucuk S, et al. Effectiveness of tibolone on hypoestrogenic symptoms induced by goserelin treatment in patients with endometriosis. Fertil Steril. 1997 Jan;67(1):40-45. PMID: 8986681
  38. Vercellini P, Trespidi L, Colombo A, et al. A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis. Fertil Steril. 1993 Jul;60(1):75-79. PMID: 8513962
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