endometriosis DOES ENDOMETRIOSIS REALLY CAUSE PAIN Does endometriosis
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endometriosis DOES ENDOMETRIOSIS REALLY CAUSE PAIN?
Does endometriosis cause pain? Yes, but not always Many influences, including Oestrogen endometriosis Full Pain History Surgery not the only answer Improved understanding of pathophysiology
Prevalence 10% of population Who? 176 million women worldwide • 20% of hysterectomies • 40% Laparoscopies Still don’t know endometriosis Complex Why? Genetic and Environmental Factors Inheritability-50% Environmental Diet, BMI Gastrointestinal (IBS, IBD), What else Urological (PBS), Muscular-skeletal (fibromyalgia, pelvic floor dysfunction)
endometriosis What? Superficial Peritoneal Ovarian Endometrioma Deep Infiltrating Endometriosis (DIE) Pain Sub-fertility How? History Examination Specialist Ultrasound Scan/Transvaginal Scan Diagnosis and Plan (MRI) When? Median delay in diagnosis 7 -8 years
endometriosis What to do? Medical NSAIDs Reduction of menses/suppression of ovulation COCP Monophasic eg Levonogestrel 150 ug/Ethyinylestradiol 30 ug Progestins (Aromatase Inhibitors (+ addback E 2)) (Gn. RH agonists, Androgenic steroids) Surgical Laparoscopy. Direct visualization/Biopsy Laparotomy
endometriosis Pain Good evidence that surgery improves pain symptoms, BUT Placebo effect 30% Non-Response 20% Symptom recurrence 50% at 5 years, some very quick recurrence No or minimal progression in 80% Laparoscope and Treat Excision/Ablation-no difference Asymptomatic follow-up surgery-no benefit/risks
endometriosis Fertility Medical management No evidence of improvement with ovulation suppression, including adjunctive medical management pre or post surgery Improvement in ART with medical management Surgical Management Stage I-II endometriosis Excision improves pregnancy rates, probably also improves ART Stage III-IV endometriosis Excision improves natural pregnancy rates. No good data for ART Endometrioma Excision of capsule improves spontaneous pregnancy rates Reduction in ovarian reserve No evidence for improvement for ART Pregnancy outcomes Increase adverse outcomes incl placenta praevia, PET, prematurity, APH, C/S
Team Approach Physiotherapy endometriosis Psychological Medicine Pain Management Specialist
