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wolverine
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Joined: 16 Jan 2007
Posts: 394
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 Posted: Sun May 06, 2007 11:56 am Post subject: Structured vivas: Management of Endometriosis |
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| Found it Abi! Will you kick off? |
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wolverine
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Joined: 16 Jan 2007
Posts: 394
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| Posted: Sun May 06, 2007 11:58 am Post subject: |
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Ok I've thought of one!
Management of moderate- severe pelvic endometriosis!  |
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Abik
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Joined: 15 Jan 2007
Posts: 243
Location: Poole
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| Posted: Sun May 06, 2007 12:14 pm Post subject: |
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thanks! 
History - pain, dyspareunia, menorhagia - clots/flooding/night-time, cycle length and frequency, smears, PMH - anything to contraindicate oestrogens? multiple laps? , treatments tried, how diagnosis made? plans - fertility, past Obs hx,
Examination - anaemia, BP, fixed retroverted uterus, uterosacral nodules, vaginal/ cervical endo? other ectopic sites? adnexae
Investigations - exclude endometriomas with USS as these need surgery, FBC, CA 125?, laparoscopy if diagnosis not clear/ medical management failed.
Treatment - conservative - exercise, do nothing??
medical - analgesia - NSAIDS (work well!!), COCP, progesterones, Mirena IUS, GNRH analogues with add-back livial for 6 months - 1 year.
Surgery - laparoscopy and ablation/excision/removal endometriomas, laparotomy may be needed, pelvic clearance?
Other - support groups, fertility - clomid, IUI (stimulated), IVF
treatment aims - symptom control = all medical treatments same efficacy with high recurrance rates on stopping. Treatment prior to IVF increases rates.
fertility = surgery increases pregnancy rates in all stages of disease. Endometrioma removal helps with IVF. clomid/IUI/IVF all helpful |
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Abik
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Joined: 15 Jan 2007
Posts: 243
Location: Poole
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| Posted: Sun May 06, 2007 12:24 pm Post subject: |
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OK some extra information from the guidelines-
Symptoms - bladder/ bowel incl dyschezia & ovulation pain (all poor predictors of disease.
Histology is gold-standard for diagnosis.
Medical - danazol, gestrinone (always forget these - what do they do?) MPA
If deeply infiltrating consider MRI/IVP and referral to specialist centre.
Surgery better than medical for both pain and infertlity (I don't think, thanks Tyrone!!!) |
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EMAK
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Joined: 26 Nov 2006
Posts: 572
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| Posted: Sun May 06, 2007 1:54 pm Post subject: |
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| Abik wrote: | | fertility = surgery increases pregnancy rates in all stages of disease. |
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Ablation of endometriotic lesions plus adhesiolysis to improve fertility in minimal–mild endometriosis
is effective compared with diagnostic laparoscopy alone.
so in moderate to sever endometriosis it is not associated with enhanced fertiliyt.
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Ref: GTG[/b] |
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EMAK
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Joined: 26 Nov 2006
Posts: 572
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| Posted: Sun May 06, 2007 1:56 pm Post subject: |
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| The role of surgery in improving pregnancy rates for moderate-severe disease is uncertain. |
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Abik
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Posts: 243
Location: Poole
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| Posted: Mon May 07, 2007 10:05 am Post subject: |
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| EMAK wrote: | | The role of surgery in improving pregnancy rates for moderate-severe disease is uncertain. |
unless you read the NICE guideline on fertility! (1.8.2.3) |
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EMAK
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Joined: 26 Nov 2006
Posts: 572
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| Posted: Mon May 07, 2007 2:58 pm Post subject: |
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My reference is the recent Green Top Giudline about Endometriosis..  |
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