Endometriosis

Question 1

Endometriosis and endometrioma

Answer 1

It’s advisable to have egg 1reservation before doing laparoscopic endometrioma cystectomy as it decreases the AMH by 50% due to its thick wall of the cyst
2- it’s better to give continuous COCP.
3- GNRH

Question 2

Important points in Endometrisis

Answer 2

Pain:
Chronic pelvic pain (>6 months)
Abdominal cramps or back pain during menstruation
Very painful menstrual cramps
Painful bowel movements (Dyskesia)
Painful urination, especially during menstruation (dysurea)
Abnormal or heavy bleeding during periods (dysmenorrhoea)
Painful sex (Deep Dysparunea
women with endometriosis often report experiencing fatigue and depression.
Infertility is significantly more common in patients with endometriosis, with a doubling of risk compared with women
without endometriosis.
Endometriosis is discovered in 30-50% of women who present for assisted reproductive treatment.
Horne AW. Missmer SA, Pathophysiolory, diagnosis, and management of endometriosis, BMI, 2022

Question 3

Non Hormonal Treatment of endometriosis

Answer 3

Non-Hormonal Pain support
Use as analgesic ladder step by step approach.
• Paracetamol
• NSAIDS
• Antispasmodics - Buscopan / mebeverine
• CBD oil 10%
• Melatonin 2-10mg per day
• Duloxetine and amitriptyline may also be used as co-analgesics
• severe burning pain - gabapentin or pregabalin
• Opiates

Question 4

Hormonal treatment of endometriosis

Answer 4

Hormonal treatment:
• Principle of treatments is to stop periods and counteract estrogen
• Combined Oral Contraceptive continuous or cyclic use
• Progesterone
• IUS - Mirena
• GRH agonists and antagonists
• Aromatase inhibitors
• Dienogest - only medicine licensed for the treatment of endometriosis

Question 5

Dienogest

Answer 5

Dienogest - efficacy
• Medical therapy for post operative management
- A systematic review looked at endometriosis recurrence in patients treated with dienogest over a mean follow-up of 29 months
• The recurrence was 2 per 100 women versus 29 per 100 women managed expectantly
- Another systematic review compared to mirena, GNRH and no treatment demonstrated a lower rate of disease recurrence and no difference in pregnancy rates.
- RCT post operative treatment of severe endometriosis compare dienogest with GNRH agonists - both showed highly significant reduction of pain at o and 30 months, without any signiticant
difference (p < .001). Dienogest had fewer side effects(p = .026).

Question 6

Dienogest

Answer 6

Dienogest
• Licensed treatment for endometriosis
• Take a tablet 2mg once daily
• Not licensed contraception
• Side effects

Question 7

Medical treatment for endometriosis