父与子图片Overview of the treatment of endometriosis
Author
Robert S Schenken, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Kristen Eckler, MD, FACOG
口口声声的意思Disclosures: Robert S Schenken, MD Nothing to disclo. Robert L Barbieri, MD Nothing to disclo. Kristen Eckler, MD, FACOG Nothing to disclo.依赖
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Literature review current through: Oct 2014. | This topic last updated: Jul 24, 2013.
INTRODUCTION — According to the Practice Committee of the American Society for Reproductive Medicine, “endometriosis should be viewed as a chronic dia that requires a life-long management plan with the goal of maximizing the u of medical treatment and avoiding repeated surgical procedures” [1]. Despite extensive rearch, the optimal management of endometriosis is unclear. This topic will review medical and surgical options for treating women with this dia. Clinical features and diagnosis of endometriosis, as well as management of thoracic endometriosis, are discusd parately. (See "Pathogenesis, clinical features, and diagnosis of endometriosis" 台阶and "Thoracic endometriosis".)
GENERAL APPROACH — Clinical manifestations of endometriosis fall into three general categories: pelvic pain, infertility, and pelvic mass. The goal of therapy is to relieve the symptoms. There is no high quality evidence that one medical therapy is superior to another for managing pelvic pain due to endometriosis, or that any type of medical treatment will affect future fertility. Therefore, treatment decisions are individualized, taking into account the verity of symptoms, the extent and location of dia, whether there is a desire for pregnancy, the age of the patient, medication side effects, surgical complication rates, and cost.
Treatment options include:
●Expectant management网上赚钱的方法
●Analgesia
●Hormonal medical therapy
•Estrogen-progestin oral contraceptives, cyclic or continuous
•Gonadotropin-releasing hormone (GnRH) agonists
•Progestins, given by an oral, parenteral, or intrauterine route
•Danazol
•Aromata inhibitors
●Surgical intervention, which may be conrvative (retain uterus and ovarian tissue) or definitive (removal of the uterus and possibly the ovaries)
●Combination therapy in which medical therapy is given before and/or after surgery
Laparoscopy is the gold standard for establishing the diagnosis of endometriosis, and provides an opportunity for conrvative surgical treatment. Therapeutic intervention is desirable at the time of diagnosis to ablate or exci implants and adhesions, thus potentially preventing or delaying dia or symptom progression. Early surgical therapy also avoids the expen and side effects of medical therapy. Potential disadvantages incl
ude inadvertent damage to adjacent organs (especially the bowel and bladder), postoperative infectious complications, and mechanical trauma to pelvic structures that may result in greater adhesion formation (e "Surgical management of pelvic pain due to endometriosis", ction on 'Conrvative versus definitive surgery').
100字加油稿After the initial diagnostic procedure, expectant management is considered primarily for two groups of patients: women with no or minimal symptoms and perimenopausal women. Although relief of symptoms is not as important for asymptomatic or minimally symptomatic women, the patients may benefit from therapy to retard progression of the dia becau studies suggest that endometriosis is a progressive dia in most women [2]. While most studies suggest that oral estrogen-progestin contraceptives reduce the incidence of endometriosis, some suggest no effect or a slight increa [3-5].
After menopau, endometriotic implant growth is suppresd as a result of markedly reduced ovarian estrogen production. Therefore, perimenopausal women with tolerable symptoms may opt for expectant management until menopau to avoid the side effects
and cost of treatment. Alternatively, analgesia with nonsteroidal antiinflammatory drugs (NSAIDs) may provide acceptable results over the short-term. Young women with significant symptoms generally require more aggressive medical or surgical therapy.
TREATMENT OF PELVIC PAIN — Women with pelvic pain and suspected endometriosis may be managed with empiric medical therapy prior to establishing a definitive diagnosis by laparoscopy [6,7]. We generally suggest analgesics and/or combined oral estrogen-progestin contraceptives for women with no more than mild pelvic pain and a GnRH agonist for tho with moderate to vere pelvic pain. The advantages and disadvantages of medical therapy of pelvic pain in women with endometriosis are listed in the table (table 1). Although 80 to 90 percent of patients will have some improvement in symptoms with medical therapy, medical interventions neither enhance fertility nor diminish endometriomas or adhesions [8-10]. Therefore, women with suspected endometriomas and advanced stages of dia, or infertility, are more appropriately managed surgically.隆科多和太后
