Treatment of pain ass with endometriosis

Question 1

Empirical tx of endometriosis

Answer 1

• Analgesia
• Hormonal contraception
• Progestogens
• Anti progestagens
• GnRh analogues

Question 2

Hormonal contraceptives and endometriosis

Answer 2

• Continuous use of OCP in dysmenorrhoea
• Use of vaginal rings
• Use of transdermal contraception

Question 3

Progestagens and anti progestagens in endometriosis

Answer 3

• Use progestagens [medroxyprogesterone acetate (oral or depot), dienogest, cyproterone acetate, norethisterone acetate or danazol]
• Use anti-progestagens (gestrinone)
• Do not use Danazol unless absolutely necessary
• Can use Mirena

Question 4

GnRH analogues in endometriosis

Answer 4

• GnRH agonists, with and without add-back therapy, are effective in the relief of endometriosis-associated pain
• No max time defined
• No specific GnRH analogue better than others
• GnRh analogues: nafarelin, leuprolide, buserelin, goserelin or triptorelin

Question 5

Aromatase inhibitors in endometriosis

Answer 5

In women with pain from rectovaginal endometriosis refractory to other medical or surgical treatment, can consider aromatase inhibitors in combination with oral contraceptive pills, progestagens, or GnRH analogues