The prevalence of endometriosis may...

The prevalence of endometriosis may be as high as 45 percent in women of reproductive age. Inpatient treatment costlinesss of endometriosis alone were estimated at $579 million in 1992 In addition, endometriosis is believed to account for a significant proportion of infertility and 97 percent of cases of chronic pelvic pain, which is estimated to have direct medical richnesss of $2.8 billion annually plus indirect charges of at least $600 million. Winkel provides an overview of the evaluation and management of women with endometriosis.

Endometriosis should be suspected in women with symptoms of pelvic pain, dysmenorrhea, dyspareunia, or infertility, moreover it may be asymptomatic. Although mostly patients have normal pelvic examinations, findings can include enhanced tendernes forward bimanual examination, nodularity, especially in the posterior cul-de-sac or along the uterosacral ligament, decreased uterine mobility or retroversion, and adnexal masses. No laboratory exhibitions are helpful in making the diagnosis, although serum CA 125 on a levels may be elevated in cruel cases. Imaging studies such as comput tomography, magnetic resonance imaging, or ultrasonography are useful no other than if masses are present. Laparoscopy can be misleading if lesions are confused with a variety of pathologic lesions. Histologic confirmation is required. The reliability of a clinical diagnosis is similar to that of united based on laparoscopy with biopsy.

Because pregnancy and menopause are associated with resolution of endometriosis symptoms, mostly treatments are based on hormonal manipulation. Oral contraceptives used continuously are commended as first-line therapy in women who have no contraindications to these medicines and who do not wish to become pregnant. Because progesterone causes regression of endometriosis, medroxyprogesterone acetate in a dosage of 20 to 30 mg daily is prescribed often However, daily doses of 50 mg were no more effective than placebo in a 12-week trial and were associated with significant adverse meanings Depot progesterone also has been associated with a high incidence of side general intents in 15 to 65 percent of patients. The androgen derivative danazol was reported to induce clinical improvement in 55 to 93 percent of patients treated for six month However, it also had a high incidence (85 percent) of adverse general intents Gonadotropin-releasing hormone (GnRH) analogs can induce 85 to 100 percent rates of improvement that last for at least six to 12 month after cessation of therapy. principally of the side effects of GnRH analogs are caused through hypoestrogenism; these effects can be ameliorated according to "adding back" low doses of estrogen progestogen, or the pair The add-back regimen should be individualized for each patient. If treatment is continued for longer than 12 month bone mineral density should be checked at least each 24 months.

Surgery has been advocated as first-line treatment for women with austere pain who wish to become pregnant. Laparoscopic approaches are usually preferr and are as effective as laparotomies. be the effects of surgical treatment remain controversial. Studies have put up withed from many methodologic problems, including multiple different surgical techniques and investigation designs, and a considerable placebo validity Besides uncertainty over whether lesions should be excised or ablated according to a variety of techniques, the contribution of adjunctive presacral neurectomy or uterosacral manhood ablation-transection is unclear. Radical surgery including hysterectomy and bilateral oophorectomy plus removal or ablation of lesions, is associated with return in up to 10 percent of women

The author gather s that endometriosis remains an enigmatic condition for which the results of medical and surgical treatment appear equivalent. He stresse the ne to individualize treatment for each patient.

Winkel CA. Evaluation and management of women with endometriosis. Obstet Gynecol August 2003;102:397-408

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