Endometriosis: Treatment Strategies

Abstract

Endometriosis is often a perplexing medical condition for both the physician and the patient. Accordingly, development of treatment strategies based on the needs of the individual patient is highly desirable. Although endometriosis has been part of the clinical practice for almost a century, many questions remain relating to the relationship between endometriosis and infertility as well as endometriosis and pelvic pain. Endometriosis is a disease of reproductive-age women, and it is now well recognized that a genetic susceptibility appears probable. The prevalence in the general population has never been clearly established. Factors to consider in management include the age and reproductive desires of the patient, the stage of the disease, and, most importantly, the symptoms. Therapeutic options include no treatment, medical therapy, surgery, or combination therapy. Oral contraceptives, androgenic agents, progestins, and gonadotropin releasing hormone (GnRH) analogs have all been used successfully, although at the present time, the latter preparations are the most popular medical therapy for endometriosis. Leuprolide acetate, goserelin acetate, and nafarelin acetate are all effective agents. Surgical therapy is appropriate, especially for advanced stages of the disease. Laparoscopy is an effective surgical approach with the goal of excision of visible endometriosis in a hemostatic fashion. Since endometriosis is a chronic condition, it is not uncommon for recurrences to occur. While endometriosis remains an enigmatic disease, the introduction of new pharmacologic agents, such as GnRH analogs and newer endoscopic methods of surgical treatment, have facilitated and improved the overall management of this disease.

Human endometriosis is associated with plasma cells and overexpression of B lymphocyte stimulator

“…Despite its high prevalence, its pathogenesis remains obscure. Although the exact origins of endometriosis are unclear, a widely accepted model postulates that endometriosis originates when some endometrial tissue, which is normally eliminated with the menstrual flow, instead undergoes retrograde flow (via the Fallopian tubes) to the ovaries and peritoneum (5,31). The endometrial tissues then develop into inflammatory foci that respond to hormonal cycles and cause the symptoms associated with endometriosis.…”

“…Because the latter is a surgical procedure, the diagnosis and subsequent treatment of endometriosis are often delayed (4). Treatment options for endometriosis include surgery and/or suppression of ovarian steroids (5). However, these strategies may offer only temporary relief because the disease usually recurs (6).…”

Análises histoquímica e morfométrica de lesões endometrióticas induzidas em ratas e tratadas com dexametasona

“…Medicamentos, como acetato de leuprolide, acetato de goserelina e acetato de nafarelina, são todos agentes passí-veis de utilização. Terapia cirúrgica é também apropriada, especialmente para fases avançadas da doença (14,23) .…”

Avaliação de dor e depressão em mulheres com endometriose após intervenção multiprofissional em grupo

“…Apesar de todo conhecimento atual sobre a endometriose, ainda não existe uma conduta ideal sem recidiva de sintomas e da doença. Muitas mulheres mantêm a queixa de dor ou de perda da fertilidade mesmo após se submeterem a diversas intervenções, gerando assim, um desgaste emocional devido ao longo caminho percorrido entre o início dos sintomas, diagnóstico e várias tentativas de tratamento da endometriose [1][2][3][4][5] . Além do sofrimento físico causado pelos sintomas, a endometriose provoca um impacto negativo na vida da mulher, alterando seu rendimento profissional, sua relação familiar e afetiva, reduzindo sua qualidade de vida e principalmente sua auto-estima 1,4-9 .…”