of
Endometriosis is one of
the most mysterious and fascinating benign gynecological disorders. It is one
of the commonest causes of chronic pelvic pain in women. It is also the most
searched disease in cases of infertility. Despite availability of many new
medical therapies and multidirectional surgical therapies of varying extents,
the management of endometriosis is still far from perfect. Newer molecules with
safer adverse effect profiles are being tried experimentally after
understanding the etiopathogenesis of the disease in depth. Neovascularization
has been thought to be one of the most essential necessities for the
development of the disease and this has prompted scientists to try agents,
which prevent development of new vessel formation. Resveratrol is one of such
therapies which may be holding the future optimistic directions in managing
endometriosis. It is found to be effective in mouse models and is a substance
easily available and has no side effects. If the bigger trials in human beings
will be successful, we will soon have a safe substance to manage endometriosis.
ndometriosis is defined as
the occurrence of ectopic endometrial tissues outside the cavity of the uterus.
These islands of endometriosis are composed of endometrial glands surrounded by
endometrial stroma, which are capable of responding to a varying degree to
cyclical hormonal stimulation. The disease owns an unique pathology of a benign
proliferative growth process yet having the propensity to invade the normal
surrounding tissues. The incidence varies from 1% to 7% in asymptomatic females
to 15% of women with chronic pelvic pain.
Endometriosis is a disease
of childbearing age. It is extremely rare before menarche and disappears after
menopause. Several theories of histogenesis have been proposed although the
mechanism by which it develops is still not completely known and no single
theory explains all cases of the disease. Trans-tubal regurgitation or
retrograde menstruation with neovascularization have been the most accepted of
multiple theories put
forward to explain the
pathogenesis of the disease. Tlie symptoms vary according to the site, and do
not correlate well with the extent of disease. The classic symptom complex includes
dysmenorrhea, dyspareunia, menorrhagia and infertility. About 30% of patients
are asymptomatic. Transvaginal ultrasound and laparoscopy generally clinch the
diagnosis.
Minimal asymptomatic cases
should be observed for 6-8 months. Infertility should be investigated and
treated as necessary. All symptomatic women need treatment, which depends on
the age of the patient, need for preserving reproductive functions, severity of
the symptoms, extent of disease, response to medical treatment, relief obtained
with previous conservative surgery and attitude of the patient towards her
problem.
Principle of treatment
of minimal endometriosis as diagnosed by Laparoscopy:- Endometriosis is one of the most mysterious and
fascinating benign gynecological disorders.
The objective of the treatment is to reverse and if possible, eliminate
disease process, alleviate symptoms, facilitate childbearing and enable the
patient to lead a good quality-of-life. The treatment, therefore, needs to be
individualized. A combination of medical and surgical treatment may serve the
purpose in most of the cases. The treatment of mild and moderate endometriosis with hormonal
preparations may not offer any advantage over expectant management in promoting
conception. The medical treatment
includes the use of 1) combined oral
contraceptive pills, 2) oral progestogens, 3) danazol or
4) gestrinone, 5) gonadotropin-releasing
hormone (GnRH) and 6) aromatic
inhibitors.
Role of Resveratrol
in management of Endometriosis
Although it has been
extensively investigated in the past century, it remains an enigmatic disease
process. The often subtle and varied appearances of endometriosis can make
recognition and surgical staging difficult, thereby casting doubt on the
utility of the classification systems that have been developed. There are many controversies and uncertainties that have led to use of certain unconventional
or less documented therapies, which may be helpful in managing the disease or
preventing the complications. The medical therapy for endometriosis is symptomatic
rather than curative. Most women experience pain relapse at stoppage of treatment because restoration of ovulation and
of physiological levels of estrogen restore the metabolic activity of both
eutopic and ectopic endometrium.
Pathogenesis of Endometriosis; Is an novel anti-angiogenic agents
available worldwide??
No comments:
Post a Comment