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Endometriosis

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  • 1. ENDOMETRIOSIS www.freelivedoctor.com
  • 2. www.freelivedoctor.com
  • 3. www.freelivedoctor.com
  • 4. www.freelivedoctor.com
  • 5. www.freelivedoctor.com
  • 6. 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?
    www.freelivedoctor.com
  • 7. 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
    www.freelivedoctor.com
  • 8. 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
    www.freelivedoctor.com
  • 9. 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
    www.freelivedoctor.com
  • 10. www.freelivedoctor.com
  • 11. www.freelivedoctor.com
  • 12. www.freelivedoctor.com
  • 13. 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
    www.freelivedoctor.com
  • 14. Familial association
    • Relative Risk to siblings 2.3 overall
    • Relative Risk to sibs if severe endo 15
    www.freelivedoctor.com
  • 15. Risk factors
    • Single/nulliparous
    • Early menarche
    • Non oral contraception
    • Non smoker shorter cycle/longer duration of flow
    • Dysplastic naevus syndrome, melanoma
    www.freelivedoctor.com
  • 16. symptoms
    • 90% severe dysmenorrohoea
    • 70% chronic pelvic pain
    • 75% dyspareunia
    • 55% infertility
    www.freelivedoctor.com
  • 17. Infertility mechanisms www.freelivedoctor.com Adhesions distorsion Increased PGs Cell mediated gamete inj Defective folliculogenisis Chronic salpingitis Activated macrophag Increased prev. ABs LUFFS Altered tubal motil Cytokines Fertilization failure hyperprolactinaemia Impaired oocyte pick up Sperm phagocytosed Early spon abortion Luteal phase deficency
  • 18. www.freelivedoctor.com
  • 19. 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
    www.freelivedoctor.com
  • 20. treatment of menstrual pain
    • Treatment level of evidence
    • Simple analgesics 1
    • Herbal remedies 1
    • alcohol 2
    • Antidepressants/anxiolytics 2
    • OCPs 1
    • NSAIDS 3
    www.freelivedoctor.com
  • 21. ENDOMETRIOSIS PAIN
    • PSYCO-PHYSICAL TREATMENTS-ACCUPUNCTURE, MESSAGE, RELAXATION, TENS
    • EXERCISE
    • ANTI-OESTROGEN DRUGS
    • LAPAROSCOPY/ OPEN SURGERY
    www.freelivedoctor.com
  • 22. 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
    www.freelivedoctor.com
  • 23. META-ANALYSIS MIN/MILD ENDOMETRIOSIS www.freelivedoctor.com PREG RATE n FOLLOW-UP NO TREAT 44% 235 0.5-3 DRUG THERAPY 41% 418 1- 5 SURGERY 65% 912 1 - 6 IVF 20 257
  • 24. www.freelivedoctor.com