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