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CLINICAL GUIDELINE FOR THE TREATMENT OF
ENDOMETRIOSIS
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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.
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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.
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Endometriosis
The pathogenesis is unknown.
Theories include:
•Retrograde menstruation
•Genetic allele HLA-B7
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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.
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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.
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Female Reproductive System
www.Patient.co.uk/diagrams.asp
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Sites of Ectopic Implants in Red
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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.
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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.
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Laparoscopy Procedure
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Endometrial Changes
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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
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Stage ll/ Mild6-15 Points
• Deep lesions present in the cul-de-sac area between the uterus and the rectum.
Endochick.wordpress.com
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Stage III/ Moderate16-40 Points
Endochick.wordpress.com
• Implants are found on the ovaries.
• Symptoms are common at this
stage.
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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
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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
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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