复旦大学上海医学院妇产科学系2009级八年制妇产科学课件 内异症（英文）.ppt

Treatment options Surgery Laparoscopy or laparotomy Radical or conservative Non-surgical treatment (medication) First-line medication Progestins Gonadotropin-releasing hormone (GnRH) agonists Danazol (androgenic) Oral contraceptives Controlled ovarian hyperstimulation (fertility treatment) Surgery Indications Medical treatment ineffective Size of the adnexal mass 5 cm Wishing to get pregnant Purposes Accurate diagnosis Removal of endometriotic lesions as much as possible Removal of adhesion and restoration of normal anatomy Surgery: Pros and cons Pros Proven efficacy Cons Invasive Costly Certain risks Due to high recurrence risk (~50% 5 yrs), 2nd surgery may be needed Increases the risk of damaging ovaries, and the risk of premature ovarian failure Medical treatment: Expectant treatment Use NSAIDs Asprin Other analgesics such as ibuprofen Selective COX-2 inhibitors Little impact, if any, on endometriotic lesions Follow-up Medical treatment Principles (for current treatment modalities) To suppress ovarian estrogen production (GnRH-a and danazol) necessary for the development and maintenance of ectopic endometrium To induce a pseudo-pregnency (progestins and OC), which suppresses ovulation and estrogen production With reduced estrogen production, endometriotic lesions may shrink in size or may be eliminated All are short-term; recurrence after termination All have various side-effects ~10% simply do not respond to pregestin therapy Progestin treatment Based on a serendipitous finding that pregnancy relieves the sysmptoms of endometriosis Mechanism of action (MOA) Suppresses ovulation Suppress the growth of endometriotic lesions Reduce inflammation Progestins Oral Norethisterone acetate Cyproterone acetate Dienogest Intramuscular route Medroxiprogesterone acetate Intrauterine route Levonorgestrel-releasing IUD Side-effects Spotting, hot-flashes, breakthrough bleeding GnRH agonists treatment MOA Negative feedback control of ovarian estrogen production Method of