Q5. Do you advocate the policy of implementing medical treatment of endometriosis (Danazole/MPA/agonists/Letrozole/Gestrinone/Mifepristone) ON?

Q.6. 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?

Q7. How many times you have come across carcinomatous changes in pelvic endometriosis? Any personal experience/case - you can sadly recall?

Symptom 4:-Endometriosis and subfertility.

 Endometriosis and subfertility: - Briefly, what is the role of medical treatment –Prior to Diag Lap/ or after Diag Lap.   Trying time /couple age counts. Treatment planning.

The materials released act as ROS. Normally what happens is that at ovulation it cause release of ROS (reactive oxygen species) and these naturally occurring ROS are counteracted normally by naturally present anti-oxidants and Redox enzymes.

Some advocate a short period of medical treatment after Lap procedure but before IUI/ ART with the idea that endometriotic spots will be quiescent during fertility enhancing treatments (CC/hMG/IUI/IVF-ET). What is your view?

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An emerging problem of great magnitude :-Choice of HRT IN A PROVEN CASE OF ENDOMETRIOSIS AFTER LH-BSO

Persistence of the disease even after menopause- Mechanism?

And the issue of Myoma.

Types of intervention if needed:-

Open laparotomy 2) Laparoscopic 3) Hysteroscopic with new morcellator (TRUCLEAR/MyoSure morcellator) with cold blades   3) robotically assisted laparoscopic myomectomy 4) Myolysis 5) UAE (Uterine artery embolization)-possibly does not improve fertility. 7) MRgFUS (magnetic resonance guided focused ultrasound surgery): Trade name is ExAblate-multiple ultrasound arrays –beams converge on targeted myoma coagulative necrosis.

Often endometriosis is also present and unless both the conditions are treated concomitantly then infertility/ pelvic pain /dysmenorrhoea/menorrhagia will persist.

The issue of adenomyomata: - How many times you have opened up with the provisional diagnosis of myoma and finally it turned out to be localized adenomyomata?

Coexistence of microscopic  endometriosis.

There is significant overlap of symptoms of endometriosis and myoma as such thorough evaluation including cavitary assessment by hysteroscopy of both these condition is mandatory. For CPP- if diag Lap contemplated then addl. hysteroscopy is a must -as 30% will exhibit some abnormalities .Otherwise there will be treatment failures.