Endometriosis is a leading systemic, debilitating disease that has a wide range of physical and mental symptoms, affecting the quality of life of women all over the world.
Pain, menstrual cramps
Both pharmacologic treatment and surgical intervention are available.
Major medical treatments include NASID/pain medications, progestins, estrogen/progestin combo, and GnRH (agonists/antagonists), and all should be considered suppressive rather than curative; the goal of hormonal treatments is to induce a local hypoestrogenic state by suppressing ovulation.
Surgery is indicated for failure or intolerance of medical treatment or the purposes of diagnosis and immediate treatment; laparoscopic surgery could effectively manage the pain in short-term, but with a high recurrence rate and limited data to show fertility benefit; hysterectomy is the definitive treatment but highly invasive and leads to permanent fertility loss.
Without hormonal suppression, the 5-year recurrence risk post-surgery is ~50%,[4] multiple surgeries are not recommended but are not uncommon in this population.
Sources
[1]. Taylor HS, et al, Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021 Feb 27;397(10276):839-852.
[2]. Falcone T, Flyckt R. Clinical Management of Endometriosis. Obstet Gynecol. 2018 Mar;131(3):557-571.
[3]. Agarwal SK, et al. Rethinking endometriosis care: applying the chronic care model via a multidisciplinary program for the care of women with endometriosis. Int J Women’s Health. 2019 Jul 23;11:405-410.
[4]. Falcone T, Flyckt R. Clinical Management of Endometriosis. Obstet Gynecol. 2018 Mar;131(3):557-571.
[5]. China Endometriosis Treatment Guideline (2021).
[6]. Van Oostrum N, De Sutter P, Meys J, Verstraelen H. Risks associated with bacterial vaginosis in infertility patients: a systematic review and meta-analysis. Hum Reprod. 2013 Jul;28(7):1809-15.
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