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...
Symptoms
Infertility 40 % Dysmenorrhoea 60 %
Chronic
Pelvic
Pain 80%
Pain
Premenstrual
Intramenstrual
Postmenstrual
100%
D...
Pathogenesis ??
Endometriosis is said to be
Estrogen dependent .
It is one of the major causative
factors in the developme...
Excess Estrogen stimulates
Inflammation
Invasion
Angiogenesis
Cell 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 l...
When is medical treatment
required
• First line treatment with chocolate cyst?
• First line treatment with superficial / d...
Limitations of surgery
Skill
High risk of recurrence after surgery
25 % recurrence after 2 years
50 % at 5 years
40 – 80 %...
Medication Limitation
NSAIDs Lack of supporting evidence from controlled trials
GI side effects
Risk of gastric ulceration...
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, 011-22058865
WEBSITE :
ww...
THANK YOU
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Endometriosis An Overview Dr. Namitha Kapoor, Dr. Sharda jain , Dr. jyoti Agarwal, Dr. jyoti Bhaskar

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Endometriosis An Overview Dr. Namitha Kapoor, Dr. Sharda jain , Dr. jyoti Agarwal, Dr. jyoti Bhaskar

  1. 1. Endometriosis : An Overview DR .NAMITHA KAPOOR Dr. Sharda Jain Dr. Jyoti Agarwal Dr. Jyoti Bhaskar
  2. 2. •Diagnostic Dilemma •Debilitating Disease •Progressive Disease •Disease with “No Cure” • A Gynaecologist’s dilemma
  3. 3. PREVALENCE •10% Prevalence is higher in women with • Dysmenorrhea : upto 60% • Dyspareunia : upto 44% • Pelvic Pain : upto 80%
  4. 4. Symptoms Infertility 40 % Dysmenorrhoea 60 % Chronic Pelvic Pain 80% Pain Premenstrual Intramenstrual Postmenstrual 100% Dyspareunia 45 %
  5. 5. Pathogenesis ?? Endometriosis is said to be Estrogen dependent . It is one of the major causative factors in the development of endometriosis.
  6. 6. Excess Estrogen stimulates Inflammation Invasion Angiogenesis Cell Proliferation Adhesions Pain
  7. 7. Treatment Achieve Reduced Estrogenic State (Short of Hypoestrogenism)
  8. 8. Current Treatment options SURGICAL MEDICAL Removal of Superfical and Deep lesions Adhesiolysis To destroy or prevent the lesions ( Not Possible) Removal of Chocolate cysts
  9. 9. 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 ?
  10. 10. Limitations of surgery Skill High risk of recurrence after surgery 25 % recurrence after 2 years 50 % at 5 years 40 – 80 % women have PAIN again within 2 years of surgery
  11. 11. Medication Limitation NSAIDs Lack of supporting evidence from controlled trials GI side effects Risk of gastric ulceration Anti-ovulatory effect, when taken at mid cycle Combined Oral Not approved for endomteriosis in most countries Contraceptives Break through bleeding GnRH Agonist Causes hot flushes, vaginal dryness and decreased libido (Leuprolide) Acceleration of bone mass loss; increased risk of osteoporosis Use 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 trials Lack of dose finding data Adverse impact on BMD
  12. 12. ESHRE guidelines states “Progestin can be considered as a first choice for the treatment of endometriosis”
  13. 13. ESHRE guidelines 2014 Best so far Will answer all your queries
  14. 14. March is Endometriosis Awareness Month
  15. 15. ADDRESS 11 Gagan Vihar, Near Karkari Morh Flyover, Delhi - 51 Helpline 9650588339, 011-22414049, 011-22058865 WEBSITE : www.lifecarecentre.in www.drshardajain.com www.lifecareivf.com E-MAIL ID Sharda.lifecare@gmail.com Lifecarecentre21@gmail.com info@lifecareivf.com &
  16. 16. THANK YOU

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