وصف
Medical management of endometriosis typically involves the use of hormonal therapies such as birth control pills, progestins, or GnRH agonists to reduce estrogen levels and suppress the growth of endometrial tissue. Pain management with NSAIDs, as well as targeted treatments like aromatase inhibitors or the use of intrauterine devices (IUDs), can help alleviate symptoms. In some cases, additional treatments like surgery may be considered for severe cases or when fertility is a concern.
ملخص
- Endometriosis is a chronic inflammatory condition where endometrial tissue (glands and stroma) exists outside the uterine cavity. Its pathogenesis remains unclear, contributing to management controversies and significant quality of life reduction for affected women. It affects 10-15% of reproductive-aged women and is a major cause of infertility (25-35%).
- Ectopic endometrial lesions can appear nearly anywhere in the body, including the uterine serosa, ovaries, bladder, bowels, and even distant locations like the lungs and pleura. The most prominent theory is retrograde menstruation, but others include celomic metaplasia, lymphatic/vascular spread, and immunological/genetic factors. Key mechanisms include estrogen dependency and chronic inflammation.
- Common clinical features include chronic pelvic pain, dysmenorrhea (70-90% of patients), dyspareunia, dyschezia, and infertility (25-35%). Symptom severity varies and doesn't always correlate with the extent of the disease, significantly impacting women's physical, emotional, and social well-being.
- Diagnosis involves a detailed menstrual and pain history, imaging, and laparoscopy with histopathological confirmation (gold standard). Transvaginal sonography (ground glass appearance) is used initially, followed by MRI if needed. Laparoscopic findings include gun metal or blue-gray spots, scarring, and adhesions. Staging (1-4) based on lesion extent, location, and adhesion presence may not correlate with symptom severity.
- Medical management aims to alleviate pain and improve quality of life, potentially minimizing disease progression and reducing the need for repeated surgeries. If the patient presented with pain, first-line treatment starts with non-hormonal medications (NSAIDs) then, depending on the severity, hormonal preparations like progesterogens (oral, injectable, LNG IUD) or OCPs may be considered.
- Second-line therapies, like GnRH agonists and danazol, are reserved for severe cases due to more significant side effects. GnRH agonists cause a hypogonadotropic state, leading to menopausal-like symptoms managed with add-back therapy (progestins or estrogen/progestin). Danazol, an androgenic medication, is now rarely used due to significant androgenic side effects. Gastrinone, a steroidal hormone, offers another alternative with fewer androgenic side effects.
- Surgical management is indicated for failed medical therapy, severe symptoms, infertility associated with advanced disease, large ovarian endometriomas, or diagnostic uncertainty. Laparoscopy is preferred, involving excision (complete removal) or ablation (superficial destruction) of lesions. Excision has lower recurrence rates, while ablation is simpler but recurrence is high.
- Post-surgical management addresses the high risk of recurrence (up to 50% within 5 years) and further adhesion formation. Hormonal therapy is often used to delay recurrence after surgery, with a focus on multidisciplinary follow-up for symptom control and family planning. Tailored, patient-centered approaches, incorporating shared decision-making, are essential for effective endometriosis management.
نموذج شهادة
حول المتحدثين
Dr. Richa Saxena
Director Professional Publishing, Jaypee Brothers Medical Publishers, New Delhi
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