Treatment of pelvic pain associated with endometriosis

doi:10.1016/j.fertnstert.2006.08.072

Cited by 13 publications

(4 citation statements)

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“…It is common practice that a combination of surgery, hormonal medication and IVF is usually recommended to women with endometriosis-associated infertility. However, there are limited data about the efficiency of the various forms of treatment because the number of randomized controlled trials has so far been too small [23]. …”

Section: Discussionmentioning

confidence: 99%

Pregnancy Rate in Endometriosis Patients according to the Severity of the Disease after Using a Combined Approach of Laparoscopy, GnRH Agonist Treatment and in vitro Fertilization

Sõritsa

Saare²,

Laisk³

et al. 2014

Gynecol Obstet Invest

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Aim: To evaluate the effects of combined treatment approaches on endometriosis-associated infertility in different stages of endometriosis using laparoscopy, gonadotropin-releasing hormone (GnRH) agonist (GnRHa) therapy and in vitro fertilization (IVF). Methods: This retrospective study was carried out on 179 women with surgically confirmed endometriosis. Patients were divided into subgroups: group 1 (stage I-II, n = 121) and group 2 (stage III-IV, n = 58). Patients eligible for IVF, who were found to have adenomyosis or moderate to severe endometriosis, were also given postoperative GnRHa. Pregnancy and delivery rates were cumulatively calculated during 5 years according to the severity of the disease. Results: The overall pregnancy, delivery and miscarriage rates were 66.5, 56.4 and 15.1%, respectively, for all patients following spontaneous and assisted conception. There were no significant differences in reproductive outcomes between the study groups. The pregnancy and delivery rates were also comparable within group 1 between the patients with and without GnRHa treatment. Conclusion: Pregnancy and delivery rates at different stages of endometriosis were not affected by the different approaches used for infertility treatment, with >60 and >50% of patients having conceived and delivered a baby, respectively, in both groups. The usefulness of GnRHa treatment for endometriosis patients with minimal to mild forms is questionable and deserves further studies.

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Section: Discussionmentioning

confidence: 99%

Pregnancy Rate in Endometriosis Patients according to the Severity of the Disease after Using a Combined Approach of Laparoscopy, GnRH Agonist Treatment and in vitro Fertilization

Sõritsa

Saare²,

Laisk³

et al. 2014

Gynecol Obstet Invest

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“…El tratamiento de la EIP puede ser médico o quirúrgico. El manejo médico hormonal es la primera consideración, es eficiente y bien tolerado para disminuir los síntomas dolorosos en el 70 al 100 % (16,17). La cirugía está indicada en pacientes que no responden a manejo médico previo y debe basarse en factores como la edad de la paciente, la intensidad del dolor (escala visual análoga mayor a 7), riesgo de obstrucción intestinal y deseo de fertilidad (9) así como mejoría en la calidad de vida y la función sexual (17)(18)(19)(20)(21).…”

Section: Introductionunclassified

Seguridad del manejo laparoscópico de pacientes con endometriosis infiltrativa profunda, en un centro de referencia en Pereira, Colombia. Cohorte retrospectiva, 2007-2016

Zambrano-Moncayo¹,

López-Jaramillo²,

López-Isanoa³

et al. 2019

Rev. Colomb. Obstet. Ginecol.

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Objetivo: describir los hallazgos intraoperatorios, los procedimientos realizados y la seguridad del manejo quirúrgico por vía laparoscópica de la endometriosis infiltrativa profunda (EIP). Materiales y métodos: cohorte histórica descriptiva. Ingresaron pacientes con sospecha diagnóstica prequirúrgica de EIP por hallazgos clínicos, ultrasonido pélvico o imágenes de resonancia magnética y con confirmación histológica de la enfermedad. Las pacientes fueron llevadas a cirugía mínimamente invasiva entre 2007 y 2016, en una institución de salud de referencia ubicada en Pereira, Colombia. Se evaluaron variables sociodemográficas, clínicas, hallazgos intraoperatorios, tipos de procedimientos realizados, complicaciones intra y posoperatorias y control del dolor a las 6 semanas. Se hace un análisis descriptivo. Resultados: se incluyeron 167 pacientes. La localización más frecuente de la enfermedad fue el tabique recto-vaginal (85,7 %). Un total de 83 pacientes (49,7 %) presentaron endometriosis intestinal. De estas, al 86 % se les realizó shaving (afeitado o nodulectomía), y al 13,2 % resección intestinal segmentaria. Un total de 4 pacientes (2,3 %) presentaron complicaciones intraoperatorias, de las cuales una requirió laparoconversión y otras 6 pacientes (3,5 %) desarrollaron complicaciones posoperatorias. Conclusiones: el manejo laparoscópico de la EIP es una alternativa por considerar, con una frecuencia de complicaciones cercana al 6 %. Se requieren estudios aleatorizados con grupo control para una mejor evaluación de la seguridad y eficacia.

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“…Одним из самых распространенных гинекологических заболеваний у женщин репродуктивного возраста считают эндометриоидную болезнь, которая является хроническим доброкачественным эстрогензависимым процессом, в основе которого лежат имплантация, рост и развитие ткани, подобной эндометрию, вне полости матки [1][2][3][4][5][6][7][8]. Частота встречаемости эндометриоза колеблется от 5 до 10 % [3,4].…”

Section: Introductionunclassified

“…Корковое вещество яичника, окружающее эндометриоидную кисту и образующее ее стенку, отличается от здоровой ткани низкой плотностью фолликулов и меньшей кортикоспецифичностью стромы [10]. При эндомет риоидных кистах необходимо хирургическое вмешательство, а также создание долгосрочного плана лечения с максимальным использованием медикаментозной терапии, часто отрицательно влияющей на овариальный резерв [8]. следовательно, помимо негативного влияния самого заболевания приходится также учитывать воздействие на репродуктивные возможности женщины оперативных вмешательств на яичниках и последующей гормональной терапии [11][12][13].…”

Section: Introductionunclassified

An alternative method of surgical treatment of ovarian endometriomas from the standpoint of preservation of the ovarian reserve

et al. 2019

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Hypothesis/aims of study. Ovarian endometriomas are a great danger to the female reproductive function. In addition to the negative impact of the disease itself on ovarian reserve, the reproductive capabilities of women are influenced by surgery on the ovaries and subsequent hormonal therapy. Ovarian reserve after cystectomy of the endometriomas suffers more than after removal of other benign ovarian tumors. The solution of the problem can be obtained using sclerotherapy during laparoscopy. The aim of this study was to assess the impact of sclerosing endometriomas during laparoscopy on the ovarian reserve. Study design, materials and methods. The study involved 36 patients aged 2535 years. Inclusion criteria were genital endometriosis, endometrioma of one of the ovaries with a volume of 15100 cm3, and pregnancy planning. Exclusion criteria were uterine fibroids, endometrial hyperplasia, polycystic ovary syndrome, and the previous operations on the ovaries and uterine tubes. The main group consisted of 18 patients who underwent sclerotherapy of an endometrioma during laparoscopy with a 70% ethanol solution. The comparison group comprised 18 patients who underwent cystovariectomy with bipolar coagulation of the tumor lining. Within 4 months after surgery, gonadotropin-releasing hormone agonists were administered. An ultrasound examination of the pelvic organs and determination of anti-Mllerian hormone (AMH) level were performed before surgery, after surgery, and after hormonal treatment. Results. In both study groups, AMH level decreased immediately after surgery: in the main group, it reduced by 1.4 times, in the comparison group by 2.4 times. After termination of therapy with gonadotropin-releasing hormone agonists and recovery of the menstrual cycle, AMH level increased slightly (it was 2.9 0.40 ng/ml in the main group, and 1.8 0.24 ng/ml in the comparison group). Within 12 months after surgery, pregnancy occurred in 44.4% of patients in the main group and in 33.3% of patients in the comparison group. Over 16 months of follow-up, not a single case of recurrence of the disease was subsequently detected. Conclusion. Sclerotherapy of endometriomas during laparoscopy is supposed to be an effective and promising technique aimed at preserving the ovarian reserve in this category of patients.

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Treatment of pelvic pain associated with endometriosis

Abstract: Pain associated with endometriosis requires careful evaluation to exclude other potential causes and may involve a number of different mechanisms. Both medical and surgical treatments for pain related to endometriosis are effective and choice of treatment must be individualized.

Cited by 13 publications

References 72 publications

Pregnancy Rate in Endometriosis Patients according to the Severity of the Disease after Using a Combined Approach of Laparoscopy, GnRH Agonist Treatment and in vitro Fertilization

Pregnancy Rate in Endometriosis Patients according to the Severity of the Disease after Using a Combined Approach of Laparoscopy, GnRH Agonist Treatment and in vitro Fertilization

Seguridad del manejo laparoscópico de pacientes con endometriosis infiltrativa profunda, en un centro de referencia en Pereira, Colombia. Cohorte retrospectiva, 2007-2016

An alternative method of surgical treatment of ovarian endometriomas from the standpoint of preservation of the ovarian reserve

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