New principles in the management of endometriosis.
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Current endometriosis management inadequately selects medical treatment, but lesion type, activity, and regression after medical therapy should guide surgical and medical interventions.
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Abstract
The current management of endometriosis includes expectant, medical, surgical and combined therapies and the selection is based on the staging of the disease proposed by the American Fertility Society (AFS). This approach, however, has proven to be inadequate for the selection of medical treatment. Peritoneal endometriosis represents a range of lesions of different activity and stage of evolution. Surgical resection carries a risk of adhesion formation. Two to three months of medical therapy can induce inactivation and regression of active lesions. These factors should be taken into account in the selection of therapy. Ovarian endometrial cysts are indications for reconstructive surgery. The extent of adhesions and fibrosis, rather than the size of the cyst, determine the surgical outcome. The invaginated cortex explains the frequent association with lutein cysts. Large cysts can be conservatively treated at laparoscopy in a three-step procedure with a 3-month medical therapy between the first and second laparoscopy. Deep nodular endometriosis presents different lesions varying from fibrosis to adenomyosis. The effect of a therapeutic medical trial can be evaluated within 2 months. Different modalities are available for long-term medical therapy. Surgical resection is the treatment of choice for the adenomyosis type.
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Cited by (31)
- Endometriosis 2021
- Urocortin and corticotrophin-releasing hormone receptor type 2 mRNA are highly expressed in deep infiltrating endometriotic lesions 2016
- Pathophysiological Changes in Early Endometriosis 2012
- Endometriosis 2012
- Endometriosis 2007
- Síntomas dolorosos de la endometriosis 2006
- Symptômes douloureux de l'endométriose 2006
- Symptômes douloureux de l'endométriose 2005
- Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications 2005
- Contribution to the physiopathology, symptomatology and treatment of deep infiltrating endometriosis 2004
- Medikamentöse und konservative Therapie 2004
- Epidemiology of Endometriosis 2003
- Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease 2003
- Endometriosis is a Surgical Disease 2003
- Rezidivierende Endometriose?ein Kofaktor der vorzeitigen Menopause? 2003
- Noninvasive diagnosis of endometriosis: the role of imaging and markers 2003
- Histologic Appearance of Endometriosis Infiltrating Uterosacral Ligaments in Women with Painful Symptoms 2002
- Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis 2002
- Laparoscopic management of ovarian cysts 2000
- Endometriosis, Endometrioma, and the Problem of Adhesions 2000
- Smooth muscles are frequent components of endometriotic lesions 2000
- Endometriosis Una valoración crítica de algunos de sus supuestos 1999
- Avaliação do Tratamento Clínico da Endometriose 1999
- Uterine rupture following laparoscopic resection of rectovaginal endometriosis: a new risk factor? 1999
- A health-related quality-of-life instrument for symptomatic patients with endometriosis: A validation study 1998
- Biases in the endometriosis literature 1998
- Peritoneal endometriosis, ovarian endometriosis and adenomyotic nodules of the rectovaginal septum: a different histopathogenesis? 1997
- ENDOMETRIOSIS: MEDICAL AND SURGICAL TREATMENTEduardo 1996
- Vesical endometriosis: Report of two cases and review of the literature 1996
- Surgical Therapy of Endometriosis 1996
- Stereometric evaluation of peritoneal endometriosis and endometriotic nodules of the rectovaginal septum 1996
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