Endometriosis: A review of the diagnosis and pain management

Abstract

Endometriosis is characterized by the presence of endometrial tissues outside the uterus. It affects females in their reproductive years as it is believed to be an oestrogen dependent condition. The estimated prevalences of endometriosis in the general population are as high as 10%, and are increased in females with subfertility.The diagnosis of endometriosis is usually suspected clinically, and confirmed by transvaginal ultrasound or magnetic resonance imaging of the pelvis. The gold standard of diagnosis is surgical visual inspection of the pelvic organs by an experienced surgeon during laparoscopy.Positive histology will confirm the diagnosis; but negative histology does not exclude it. Serum CA 125 levels may be increased in endometriosis, but is a poor diagnostic tool as compared to laparoscopy.The management of endometriosis is dependent on whether the primary problem is pain or subfertility. The primary objectives of the interventions include the removal of endometriotic implants, nodules or cysts, restoration of normal anatomy, reduction of disease progression and symptomatic relief. Treatment must be individualized, taking into consideration the impact of the condition on the quality of life. This may require a multidisciplinary approach involving the pain clinic and counselling services.

Hemothorax and Hemorrhagic Ascites: A Rare Presentation of Endometriosis

“…For patients with bloody pleural effusions and ascites refractory to medical management, more definitive therapy may involve hysterectomy with salpingo-oophorectomy. 1…”

“…Endometriosis is a common diagnosis in reproductive age women characterized by the presence of endometrial tissue outside the uterine cavity. 1 Although it is typically confined to the pelvis, rare manifestations involving the thorax, abdomen or pericardium have been documented. [2][3][4][5] Even more rare is the concurrent presence of endometriosis-associated hemorrhagic pleural effusion and ascites, which can prove a diagnostic challenge.…”

Pain in Endometriosis

“…The surgical removal of lesions can sometimes prove challenging depending on the stage and grade of endometriosis, which further complicates outcomes. Surgical removal of deep infiltrating endometrial lesions reduces endometrial CPP, but is associated with significant complication rates, requiring complex surgery to remove lesions, with resection of the bowel, damage to the bladder wall and stenting of the ureter often required ( Wee-Stekly et al, 2015 ). The lowest rates of further surgery in pain management is following complete hysterectomy, with over 90% of patients remaining follow-up surgery free for up to 7 years, although the removal of the ovaries as well as the uterus is not as effective in younger women ( Shakiba et al, 2008 ).…”

Presence and upregulation of Transient Receptor Potential Vanilloid 1 (TRPV1) and Ankyrin 1 (TRPA1) in translational rat endometriosis model

“…A megjelenés helye szerint beszélünk endometriosis extragenitalis, endometriosis interna és endometriosis externa kórképekről. Ez utóbbi, az endometriosis externa a leggyakoribb forma, amely lokalizáció szerint lehet ovarialis, retrocervicalis, pelvicus peritonealis, vaginalis és cervicalis (2,3).…”