Modern Management of Endometriosis
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This paper reviews the modern management of endometriosis, discussing its prevalence, association with pelvic pain, the inadequacy of the r-AFS classification, and treatment options including medical and surgical interventions.
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Abstract
Most primary care physicians consider pelvic pain as a common clinical problem which accounts for as much as 25% of routine gynecologic office visits.1 About 15% of cases of pelvic pain are due to endometriosis.2 Endometriosis is frequently associated with several types of pelvic pain such as dysmenorrhea, chronic pelvic pain, deep dyspareunia, and, occasionally, painful defecation. Specifically, endometriosis was found in 37-74% of women undergoing laparoscopy for chronic pelvic pain.3-5
\nThe endometriosis-related pelvic pain has no relation with the localization of the lesions3-5 and with the stage of the disease, as categorized according to the revised American Fertility Society (r-AFS) classification.6 In fact, the r-AFS classification system is inadequate to express the severity of the symptomatology because it does not reflect the disease in terms of cellular mass or activity.5,7-9
\nSeveral medical treatments have been proposed to treat secondary chronic pelvic pain due to endometriosis,2 but little data are available regarding the effectiveness of these treatments on quality of life of women with endometriosis,2 which seems to be deeply impaired.9,10
\nAbout 20% of women with chronic pelvic pain due to endometriosis are unresponsive to medical treatment.2 In these selected cases, surgery represents the final diagnostic and therapeutic option.2,11,12 Several procedures have been described to treat medically untreatable pelvic
\n
\npain.13 Furthermore, nonconservative procedures such as hysterectomy14,15 are questionably effective in terms of pain relief, can even be associated with a decrease in quality of life,16 and are unacceptable to many woman who wish to preserve intact their reproductive organs.
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Cited by (28)
- Evaluating the Relative Efficacy of Synthetic and Natural Drugs in Endometriosis Adopting Molecular Modelling Approach 2024
- Inquiry into women’s pathways to diagnosis of endometriosis: A qualitative study protocol 2020
- Detection of endometriosis using immunocytochemistry of P450 Aromatase expressions in eutopic endometrial cells obtained from menstrual sloughing: a diagnostic study 2020
- Complete remission of cerebral endometriosis with dienogest: a case report 2018
- Surgical Management of Endometriosis 2018
- Ethanol sclerotherapy of ovarian endometrioma: a safe and effective minimal invasive procedure. Preliminary results 2015
- Pulmonary Endometriosis - a Rare Differential Diagnosis of Lung Cancer 2014
- HUBUNGAN CADANGAN OVARIUM, AFC, AMH PADA KASUS ENDOMETRIOSIS 2013
- Endometrioma: Computed Tomography and Magnetic Resonance Imaging 2013
- Important Initiative Roles of CD44 and Tenascin in Sampson's Theory of the Pathogenesis and Development of Endometriosis 2013
- Clinical outcome after CO2 laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis 2011
- MR Imaging in Deep Pelvic Endometriosis: A Pictorial Essay 2011
- Surgical Therapies: Rectal/Bowel Endometriosis 2011
- Ureteral endometriosis and loss of renal function: mechanisms and interpretations 2011
- Laparoscopic versus laparotomic radical en bloc hysterectomy and colorectal resection for endometriosis 2010
- Bladder endometriosis, a remarkable resemblance in a monozygotic twin 2009
- Endometriosis in Hungary 2009
- Diagnosis and Management of Bladder Endometriosis 2009
- Ureteral suspension facilitates surgery for deep pelvic endometriosis 2007
- Pathogenèse de l'endométriose 2007
- A clinical overview of endometriosis: a misunderstood disease 2007
- Bowel Endometriosis: Presentation, Diagnosis, and Treatment 2007
- Bowel endometriosis: CT-enteroclysis 2006
- Laparoscopic uterine nerve ablation versus vaginal uterosacral ligament resection in postmenopausal women with intractable midline chronic pelvic pain: A randomized study 2006
- Benign Gynecological Diseases and SERMs 2006
- Control of chronic pelvic pain 2006
- Presacral neurectomy for surgical management of pelvic pain associated with endometriosis: A descriptive review 2006
- Deep dyspareunia and sex life after laparoscopic excision of endometriosis 2006
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