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Endometriosis :
An Overview
DR .NAMITHA KAPOOR
Dr. Sharda Jain
Dr. Jyoti Agarwal
Dr. Jyoti Bhaskar
•Diagnostic Dilemma•Debilitating Disease•Progressive Disease•Disease with “No Cure”
• A Gynaecologist’s dilemma
PREVALENCE
•10%
Prevalence is higher in women with
• Dysmenorrhea : upto 60%• Dyspareunia : upto 44%• Pelvic Pain : upto 80%
Symptoms
Infertility 40 % Dysmenorrhoea 60 %
Chronic Pelvic Pain 80%
PainPremenstrual IntramenstrualPostmenstrual 100%
Dyspareunia 45 %
Pathogenesis ??
Endometriosis is said to be Estrogen dependent .
It is one of the major causative factors in the development of
endometriosis.
Excess Estrogen stimulates
InflammationInvasionAngiogenesisCell Proliferation
Adhesions Pain
Treatment
Achieve Reduced Estrogenic State
(Short of Hypoestrogenism)
Current Treatment options
SURGICAL MEDICAL
Removal of Superfical and Deep lesions
Adhesiolysis
To destroy or prevent the lesions( Not Possible)
Removal of Chocolate cysts
When is medical treatment
required
• First line treatment with chocolate cyst?
• First line treatment with superficial / deep nodules?
• Role before surgery ?
• After surgery to prevent recurrence ?
• When surgery is not possible or refused ?
Full of controversies
?
Limitations of surgery
Skill
High risk of recurrence after surgery25 % recurrence after 2 years50 % at 5 years
40 – 80 % women have PAIN again within 2 years of surgery
Medication Limitation
NSAIDs Lack of supporting evidence from controlled trialsGI side effectsRisk of gastric ulcerationAnti-ovulatory effect, when taken at mid cycle
Combined Oral Not approved for endomteriosis in most countriesContraceptives Break through bleeding
GnRH Agonist Causes hot flushes, vaginal dryness and decreased libido(Leuprolide) Acceleration of bone mass loss; increased risk of
osteoporosisUse is limited upto 6 months
Androgens Adverse effect on lipid metabolism(Danazol) Causes acne, Hirsuitism, vaginal dryness, edema, hot
flushes.Associated with liver toxicity and breast atrophy
Progestins Lack of supporting evidence from controlled trialsLack of dose finding dataAdverse impact on BMD
ESHRE guidelines states
“Progestin can be considered as a first choice for the treatment of endometriosis”
ESHRE guidelines 2014
Best so far
Will answer all your queries
March
is
Endometriosis
Awareness
Month
ADDRESS 11 Gagan Vihar, Near Karkari
Morh Flyover, Delhi - 51
Helpline
9650588339,
011-22414049, 011-22058865WEBSITE :
www.lifecarecentre.inwww.drshardajain.comwww.lifecareivf.com
E-MAIL [email protected]
[email protected]@lifecareivf.com
&
THANK YOU
