Management of endometriosis

Abstract

First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosis-related pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.

Regulation of Inflammation Pathways and Inflammasome by Sex Steroid Hormones in Endometriosis

“…Endometriosis is a multifaceted gynecological condition with an estimated prevalence of ∼10-15% of the general population (1). It is histologically defined as the presence of glands and stroma of endometrial tissue outside the uterus, mainly in the peritoneal cavity and ovaries (2)(3)(4). Reports have shown the location of these lesions in sub-peritoneal fat, recto-vaginal or recto-uterine spaces, bowel, bladder, pelvic nerves, uterosacral ligaments, ureters, anterior abdominal wall, as well as abdominal skin, diaphragm, pleura, lungs, pericardium, and brain, although these locations are usually less frequent than in pelvic structures (4)(5)(6).…”

Expression of Membrane Progesterone Receptors in Eutopic and Ectopic Endometrium of Women with Endometriosis

“…Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus, which are commonly found in the peritoneal cavity and ovaries [ 1 – 3 ]. Endometriosis is the leading cause of chronic and cyclic pelvic pain in reproductive age women, affecting 10-15 % of women worldwide; pain symptoms include dysmenorrhea, dyspareunia, dysuria, and dyschezia [ 4 , 5 ].…”

Metformin, the Rise of a New Medical Therapy for Endometriosis? A Systematic Review of the Literature

“…Combined hormonal contraceptives, are recommended as first-line therapy followed by analogs and antagonists of GnRh. In case of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary surgery is recommended ( 10 ).…”