ENDOMETRIOSIS Obstetrics and Gynaecology子宫内膜异位症妇产科.pptVIP

ENDOMETRIOSIS WHAT IS THE GENERAL PRACTICE APPROACH? FIRST – A FEW QUESTIONS! IS TREATMENT ALWAYS REQUIRED? WHO NEEDS TREATMENT? DOES ANY TREATMENT REALLY WORK? DOES TREATMENT IN YOUNG WOMEN PREVENT INFERTILITY AND PROGRESSION? I DON’T HAVE THE ANSWERS ENDOMETRIOSIS PROGRESSES IN MOST CASES OF MODERATE AND SEVERE DISEASE SPON REGRESSION CAN OCCUR IN UP TO 58% OF MILDER CASES NATURAL HISTORY IS STILL UNCHARTED TO A LARGE EXTENT HOWEVER---- MEDICAL TREATMENTS AND SURGERY FAIL TO ARREST DISEASE IN UP TO A THIRD COMBINATIONS OF TREATMENTS HAVE ALSO FAILED TO CONTROL DISEASE FOR INDEFINITE PERIODS WHEN FOLLOWED UP PREGNANCY HAS A VARIABLE EFFECT ON ENDOMETRIOSIS—PERSISTENCE, REGRESSION AND PROGRESSION AND ALSO--------- ENDOMETRIOSIS MAY OCCUR IN THE EARLY MENOPAUSE, USUALLY IN ASSOCIATION WITH HRT LAPAROSCOPIC ABLATION OF VISIBLE ENDO IN INFERTILE WOMEN IS ASSOC WITH SIGNIFICANTLY INCREASED FERTILITY RATES THERE IS NO DATA REGARDING EARLY INTERVENTION WRT PREVENTION PREVALENCE NOT PRECISELY KNOWN—2-5% 20-40% OF WOMEN IN INFERTILE COUPLE RELATIONSHIPS VS 5% OF FERTILE WOMEN BUT ALSO FOUND IN 6-43% OF WOMEN UNDERGOING LAPAROSCOPIC STERILIZATION 52% OF TEENAGES WITH CPP SYNDROME Familial association Relative Risk to siblings 2.3 overall Relative Risk to sibs if severe endo 15 Risk factors Single/nulliparous Early menarche Non oral contraception Non smoker shorter cycle/longer duration of flow Dysplastic naevus syndrome, melanoma symptoms 90% severe dysmenorrohoea 70% chronic pelvic pain 75% dyspareunia 55% infertility Infertility mechanisms Treatment of pain NSAIDS: all significantly better than placebo, studies vary which one is best Naproxen mefanemic acidaspirin Naproxen=ibuprofen Naproxen only drug with significant SEs treatment of menstrual pain Treatment level of evidence Simple analgesics 1 Herbal remedies 1 alcohol 2 Antidepressants/anxiolytics 2 OCPs