Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician?

Nicola Berlanda, Edgardo Somigliana, Maria Pina Frattaruolo, Laura Buggio, Buggio L, Dhouha Dridi, Paolo Vercellini
European journal of obstetrics, gynecology, and reproductive biology · 2016 · vol. 209 , pp. 67–71 · doi:10.1016/j.ejogrb.2016.07.513 · PMID:27544308 · W2488215599
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This paper analyzes whether surgical or hormonal treatment decisions for deep endometriosis are determined by the physician's preference rather than patient factors.

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Abstract

Deep endometriosis, occurring approximately in 1% of women of reproductive age, represents the most severe form of endometriosis. It causes severe pain in the vast majority of affected women and it can affect the bowel and the urinary tract. Hormonal treatment of deep endometriosis with progestins, such as norethindrone acetate or dienogest, or estroprogestins is effective in relieving pain in more than 90% of women at one year follow up. Progestins and estroprogestins can be safely administered in the long-term, may be not expensive and are usually well tolerated. Therefore, they should represent the first-line treatment of deep endometriosis associated pain in women not seeking natural conception. However, hormonal treatment is ineffective or not tolerated in about 30% of women, the most common side effects being erratic bleeding, weight gain, decreased libido and headache. Surgical excision of deep endometriosis is mandatory in presence of symptomatic bowel stenosis, ureteral stenosis with secondary hydronephrosis, and when hormonal treatments fail. Surgical treatment is similarly effective as compared to hormonal treatment in relieving dismenorhea, dyspareunia and dyschezia at one year follow up in more than 90% of women with deep endometriosis. Surgical removal of the nodules may require resection of the bowel, ureter or bladder, with possible severe complications such as rectovaginal or ureterovaginal fistula and anastomotic leakage. A thorough counsel with the patient is necessary in order to pursue a therapeutic plan centered not on the endometriotic lesions, but on the patient's symptoms, priorities and expectations.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Intestinal Diseases Urologic Diseases Clinical Decision-Making Disease Management Endometriosis Endometriosis Endometriosis Female Humans Intestinal Diseases Intestinal Diseases Intestinal Diseases Physicians Treatment Outcome Urologic Diseases Urologic Diseases Urologic Diseases

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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