Medical management of Endometriosis =What are the drugs that we have in our possession??

This  diseases is a chronic inflammatory disease that responds to steroidal manipulation. Creation of a steady hormonal environment with inhibition of ovulation temporarily suppresses the ectopic implants and reduces the inflammatory status as well as the associated pain symptoms.

 Pharmacological management of endometriosis must be set within the framework of long-term therapeutic strategies. As the available drugs are not curative, treatments will need to be administered for years or until women desire a pregnancy. The various therapies studied have shown similar efficacy. Consequently, based on a more favourable profile in terms of safety, tolerability and cost, combined oral contraceptives and progestins should be considered as the first-line option, both as an alternative to surgery and as a postoperative adjuvant measure. 

Caution:-Gonadotrophin-releasing hormone analogues,2) danazol and 3) gestrinone should be used when 4) progestins and 5) oral contraceptives fail, are not tolerated or are contra-indicated. Future therapies for endometriosis must compare favourably with existing drugs before hypothesizing their implementation in current practice. Medical treatment is not indicated in women seeking conception because reproductive prognosis is not amelioratedEndometriosis may present with pelvic lump, Dysmenorrhoea, Menorrhagia, Obscure pelvic pain, Subfertility

Part 1

Symptom:-1 : LUMP :: ENDOMETRIOSIS AND LUMP ABDOMEN

Q1. Preoperative steps to ease the procedure? Recommended?

  Preoperative steps to ease the procedure of enucleation of cyst wall. How to avoid cauterization of cyst wall? Any scope/relevance of progesterone therapy preoperatively as has been evidenced recently in myomectomy surgery?   What is your own policy? Any other preoperative adjuvant drugs in large sized endometrimata? 

Q2. What about preoperative agonists particularly depot forms (DECAPEPTYL Depot)?

What added precautions that you advise us regarding diagnosis and treatment of endometriosis in adolescent age group. To what extent dysmenorrhoea in adolescence can be attributed to pelvic endometriosis. Have you any reservation on the issue of Diag Lap in such age group?

 Q 3.  Special Skills for enucleation endometriomata Tips and Tricks in enucleation of endometrimata so as a considerable amount of ovarian cortex is preserved and fertility potential is minimally compromised. Any special advantage of harmonic scalpel / Laser in the surgery for endometriosis as documented in myomectomy?

Q 4. Steps, which you personally adopt to prevent postoperative adhesions as a prophylactic measure.

Q 5. Limitations of USG in diag of USG , and the issue of genital Kochs and ovarian malignancy.  Any shortfall/deficiencies on USG reports related to diagnosis of pelvic endometriosis - Sensitivity and specificity. Have you ever been unhappy with USG reports?

Q.6. How to differentiate it (endometrimata) from rare malignant ovarian tumours of adolescence? Have you ever faced such an awkward situation at operating theater? How many times you have come across a situation of opening abdomen/ Laparoscopy with the presumptive diagnosis of endometriosis and eventually found it to be genital Kochs related mass/ pain.

Q.7. Postoperative Management (steps for prevention of recurrence) after operation for endometrimata in 1) unmarried –adolescent-    2) Married / unmarried young lady who likes to differ childbearing for 3-5 years.     3) Women seeking restoration of fertility      4) married women who have completed family and sterilized.

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