clinical guideline for the treatment of endometriosis
Post on 26-Dec-2015
237 Views
Preview:
TRANSCRIPT
CLINICAL GUIDELINE FOR THE TREATMENT OF
ENDOMETRIOSIS
Endometriosis
• Endometriosis is a disorder in which cells lining the uterus (endometrium) implant in other locations in the body.
• Typically these cells can implant on the ovaries, bowel, rectum, bladder and the pelvic lining. Occasionally, some implants can travel to distant organs such as the lung, brain, and kidney.
Endometriosis
These estrogen dependent implants growand cause strictures and adhesions on organs.
These ectopic implants distort and obstruct the organ’s normal function thereby
causing pain, bleeding and infertility.
Endometriosis
The pathogenesis is unknown.
Theories include:
•Retrograde menstruation
•Genetic allele HLA-B7
Endometriosis
• Found in 5-10% of women of reproductive age in the US.
• Found in 53% of adolescents who present with pelvic pain.
• Higher incidence in Caucasian women and in women with lower BMIs.
Endometriosis
• A woman with a first degree relative diagnosed with endometriosis is 6 times more likely to develop this condition.
• Early menarche, nulliparity, frequent cycles, menses lasting 7 days or more, and a closed hymen.
Female Reproductive System
www.Patient.co.uk/diagrams.asp
Sites of Ectopic Implants in Red
Signs and Symptoms
• Some women are asymptomatic even with severe cases.• Pelvic pain is the most common.• Dyspareunia.• Bleeding with defecation, urination, or intercourse.• Inability to conceive.
Staging of Endometriosis• Staging does not classify the condition according to the severity of pain or other symptoms.
• Staging is meant to predict the chance of pregnancy.
• Points are arbitrarily assigned by the physician interpreting the laparoscopy results.
Laparoscopy Procedure
Endometrial Changes
Stage I/ Minimal1-5 Points
• Endometriosis implants appear as red dots in these photos.
• There are isolated and superficial implants growing outside the uterus.
Endochick.wordpress.com
Stage ll/ Mild6-15 Points
• Deep lesions present in the cul-de-sac area between the uterus and the rectum.
Endochick.wordpress.com
Stage III/ Moderate16-40 Points
Endochick.wordpress.com
• Implants are found on the ovaries.
• Symptoms are common at this
stage.
Stage IV/ Severe>40 Points
• There are large sized implants and extensive adhesions on several organs.
• Infertility is common at this stage.Endochick.wordpress.com
Treatment PlanTreatment Options: Provides: Examples: Cost:NSAIDs Mild pain relief. Motrin, Advil, Ibuprophen $4 List at Wal-Mart and
Target
Accupuncture Pain relief in some women.
Unknown
Monophasic OCPs Mild pain relief, slows progression.
Apri, Cyclessa, Desogen, Ortho-cept
$29.99/ 28 packFree at Health Dept?
Steroid with androgen Slows growth of implants Danazol $68.60-$110.76Low co pay
Progestins Pain relief in 80% of women, decreases growth of implants.
Avgestin/Norethind-rone Acetate PO
$89.57/ 30 tabs
GnRH Agonists Initial management & recurrent symptoms.
Leuprolide IMLupron Depo IM
$355.76-$522.25/ Box
LaparoscopyLaparotomy
Relieves severe pain by removing implants by laser.
May need to be repeated.
$1,700-$5,000
Hysterectomy Relieves severe pain, removal of ovaries provides cure.
May need hormone therapy if the ovaries are removed.
$5,000
Online.Epocrates.com Drugs.com MyMedicalCosts.com EMPR.com
References• Bulun, S.. (2009). Endometriosis Mechanisms of Disease:. The New
England Journal of Medicine, 360(3), 268-279. Retrieved January 11, 2010, from ProQuest Nursing & Allied Health Source. (Document ID: 1627865541).
• DeCherney, A., Nathan, L., Goodwin, T.M., & Laufer, N. (2007). Current diagnosis & treatment obstetrics & gynecology. New York: McGraw-Hill.
• Lee, S. (2009). Peritoneal Fluid Affects Release of IP-10 and IL-8 by Neutrophils and CD4+ T Cells. Fertility Weekly, 3-4. Retrieved from Health Source: Nursing/Academic Edition.
• www.nlm.nih.gov/medlineplus/ency/article/000915.htm• www.Patient.co.uk/diagrams.asp
top related