Description
L'endométriose est une affection gynécologique chronique caractérisée par la croissance de tissu endométrial extra-utérin, provoquant douleurs pelviennes, dysménorrhée, dyspareunie et infertilité. Ce tissu ectopique réagit aux variations hormonales, provoquant inflammation, adhérences et cicatrices. Le diagnostic repose sur les symptômes cliniques, l'imagerie (échographie, IRM) et est confirmé par laparoscopie avec biopsie. Le traitement comprend les AINS, l'hormonothérapie (contraceptifs oraux, progestatifs, analogues de la GnRH) et l'exérèse chirurgicale dans les cas graves. Des traitements de fertilité comme la FIV peuvent être nécessaires. Bien qu'incurable, un diagnostic et une prise en charge précoces peuvent soulager les symptômes et améliorer la qualité de vie.
Résumé
- Endometriosis is a chronic inflammatory condition impacting a woman's mental and physical health, potentially leading to reduced productivity and social isolation. A holistic approach is essential, addressing physical, psychological, and social well-being, with support from medical staff, family, and social support groups. Early diagnosis can enhance symptom management, lessen emotional distress, and improve treatment outcomes, especially concerning fertility.
- Initial assessment involves detailed history-taking, covering pain characteristics, associated symptoms, and the impact on the patient's life, as well as family history. Transvaginal ultrasound is the first-line imaging technique. If ultrasound results are inconclusive, diagnostic laparoscopy with biopsy can be considered. Management strategies require individualization, taking into account factors like age, reproductive desires, symptom severity, and endometriosis extent.
- Treatment modalities encompass non-medical strategies, medical strategies, medically assisted reproduction, and surgical techniques. Non-medical strategies include diet, stress reduction, and emotional support, although definitive evidence supporting their effectiveness is lacking. Medical strategies involve non-hormonal pain relief, hormonal contraception, and GnRH agonists/antagonists. Surgical options include operative laparoscopy for superficial endometriosis and endometrioma treatment.
- Assisted reproductive techniques (ART) can be utilized based on the endometriosis fertility index, sperm analysis, and genetics. Fertility preservation may be considered in severe ovarian endometriosis cases. New treatment approaches include dienogest and GnRH antagonists, which are being investigated for their efficacy and safety. Emerging tools include AI-based diagnostic tools like "imagendo" that uses MRI images, and blood tests for endometriosis like "promarker endo" to identify specific protein biomarkers.
Exemple de certificat
À propos des intervenants
Dr Vipin Kumar
Obstétricien et gynécologue consultant, NHS, Irlande du Nord, Royaume-Uni
Divulgation financière
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