@2024 Afarand., IRAN
ISSN: 2251-8215 Sarem Journal of Reproductive Medicine 2018;2(4):147-151
ISSN: 2251-8215 Sarem Journal of Reproductive Medicine 2018;2(4):147-151
Endometriosis management; A survey on medical & laparoscopic treatment
ARTICLE INFO
Article Type
Original ResearchAuthors
Saremi A.T. (*)Pooladi A. (1)
(*) “Sarem Fertility & Infertility Research Center (SAFIR)” and “Sarem Cell Research Center (SCRC)” , Sarem Women’s Hospital, Tehran, Iran
(1) Sarem Fertility & Infertility Research Center (SAFIR) and Sarem Cell Research Center (SCRC) and Medical Genetics Department, Sarem Women’s Hospital, Tehran, Iran
Correspondence
Article History
Received: April 26, 2017Accepted: October 6, 2017
ePublished: November 15, 2018
ABSTRACT
Aims
Laparoscopy is accepted as a golden standard method in treatment of endometriosis. The main objective of this study was to evaluate the effects of endometriosis management protocol using a combined drug-surgery treatment in various stages.
Materials & Methods This non-experimental and interventional study was conducted on 47 patients with confirmed endometriosis in Sarem women’s hospital (Tehran, Iran) in 2011-2012. The patients were divided into 4 groups according to the endometriosis stages of I to IV. Laparoscopy surgery (electro-coagulation and the adhesions removing) was performed for all patients, and then they treated for monthly injection of GnRH analogues. The second and third laparoscopy procedures were performed after 3 and 6 months for relevant groups, respectively.
Findings In the stage-I endometriosis group 9 (90%) patients showed complete recovery after 3 months of treatment and 1 remained case showed complete recovery after 6 months. For stage-II and stage-III groups 16 (72.7%) and 5 (50%) cases showed complete recovery after 6 months of the treatment, respectively. The remained patients of stages II and III treated with GnRH for an additional 3 months and showed complete recovery (excluding one case) after 9 months. In Stage-IV, 2 (40%) cases showed complete recovery and 3 out of 5 patients were candidate to laparotomy.
Conclusion The patients with high stages of endometriosis require more invasive and longer treatments. The success of combined drug-surgery treatment for patients in stage-I endometriosis is possible in the course of 3 months. It requires 6 months for patients in stage-II and between 6 to 9 months for patients in stage-III for complete recovery.
Materials & Methods This non-experimental and interventional study was conducted on 47 patients with confirmed endometriosis in Sarem women’s hospital (Tehran, Iran) in 2011-2012. The patients were divided into 4 groups according to the endometriosis stages of I to IV. Laparoscopy surgery (electro-coagulation and the adhesions removing) was performed for all patients, and then they treated for monthly injection of GnRH analogues. The second and third laparoscopy procedures were performed after 3 and 6 months for relevant groups, respectively.
Findings In the stage-I endometriosis group 9 (90%) patients showed complete recovery after 3 months of treatment and 1 remained case showed complete recovery after 6 months. For stage-II and stage-III groups 16 (72.7%) and 5 (50%) cases showed complete recovery after 6 months of the treatment, respectively. The remained patients of stages II and III treated with GnRH for an additional 3 months and showed complete recovery (excluding one case) after 9 months. In Stage-IV, 2 (40%) cases showed complete recovery and 3 out of 5 patients were candidate to laparotomy.
Conclusion The patients with high stages of endometriosis require more invasive and longer treatments. The success of combined drug-surgery treatment for patients in stage-I endometriosis is possible in the course of 3 months. It requires 6 months for patients in stage-II and between 6 to 9 months for patients in stage-III for complete recovery.
Keywords:
Endometriosis ,
Classification,
Treatment Protocol ,
Drug Therapy ,
Surgery,
Laparoscopy ,
Combinational Therapy ,
CITATION LINKS
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[2]Whiteman MK, Kuklina E, Jamieson DJ, Hillis SD, Marchbanks PA. Inpatient hospitalization for gynecologic disorders in the United States. Am J Obstet Gynecol. 2010;202(6):541.e1-6.
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[13]Leyland N, Casper R, Laberge P, Singh SS, Sogc. Endometriosis: Diagnosis and management. J Obstet Gynaecol Can. 2010;32(7 Suppl 2):S1-32.
[14]Wykes CB, Clark TJ, Khan KS. Accuracy of laparoscopy in the diagnosis of endometriosis: A systematic quantitative review. Int J Obstet Gynaecol. 2004;111(11):1204-12.
[15]Stratton P, Winkel C, Premkumar A, Chow C, Wilson J, Hearns Stokes R, et al. Diagnostic accuracy of laparoscopy, magnetic resonance imaging, and histopathologic examination for the detection of endometriosis. Fertil Steril. 2003;79(5):1078-85.
[16]Vercellini P, Trespidi L, Colombo A, Vendola N, Marchini M, Crosignani PG. A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis. Fertil Steril. 1993;60(1):75-9.
[17]Brown J, Pan A, Hart RJ. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev. 2010(12):CD008475.
[18]Hornstein MD, Yuzpe AA, Burry KA, Heinrichs LR, Buttram VL Jr, Orwoll ES. Prospective randomized double-blind trial of 3 versus 6 months of nafarelin therapy for endometriosis associated pelvic pain. Fertil Steril. 1995;63(5):955-62.
[19]Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev. 2004(3):CD003678.
[20]Revised American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67(5):817-21.
[21]Crosignani PG, Vercellini P, Biffignandi F, Costantini W, Cortesi I, Imparato E. Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis. Fertil Steril. 1996;66(5):706-11.
[22]Jacobson TZ, Duffy JM, Barlow D, Koninckx PR, Garry R. Laparoscopic surgery for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2009;1(4):CD001300.
[23]Sutton CJ, Ewen SP, Whitelaw N, Haines P. Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis. Fertil Steril. 1994;62(4):696-700.
[24]Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril. 2004;82(6):1633-7.
[25]Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: Cystectomy versus drainage and coagulation. Fertil Steril. 1998;70(6):1176-80.
[26]Mossa B, Ebano V, Tucci S, Rega C, Dolce E, Frega A, et al. Laparoscopic surgery for the management of ovarian endometriomas. Med Sci Monit. 2010;16(4):MT45-50.
[27]Al Kadri H, Hassan S, Al Fozan HM, Hajeer A. Hormone therapy for endometriosis and surgical menopause. Cochrane Database Syst Rev. 2009;1(1):CD005997.
[28]Abbott J, Hawe J, Hunter D, Holmes M, Finn P, Garry R. Laparoscopic excision of endometriosis: A randomized, placebo-controlled trial. Fertil Steril. 2004;82(4):878-84.
[29]Mahmood TA, Templeton A. The impact of treatment on the natural history of endometriosis. Hum Reprod. 1990;5(8):965-70.
[30]Crosignani PG, Luciano A, Ray A, Bergqvist A. Subcutaneous depot medroxyprogesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain. Hum Reprod. 2006;21(1):248-56.
[31]Guzick DS, Huang LS, Broadman BA, Nealon M, Hornstein MD. Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Fertil Steril. 2011;95(5):1568-73.
[32]Muzii L, Marana R, Caruana P, Mancuso S. The impact of preoperative gonadotropin-releasing hormone agonist treatment on laparoscopic excision of ovarian endometriotic cysts. Fertil Steril. 1996;65(6):1235-7.
[33]Hornstein MD, Hemmings R, Yuzpe AA, Heinrichs WL. Use of nafarelin versus placebo after reductive laparoscopic surgery for endometriosis. Fertil Steril. 1997;68(5):860-4.
[34]Dunselman GA, Vermeulen N, Becker C, Calhaz Jorge C, D'Hooghe T, De Bie B, et al. ESHRE guideline: Management of women with endometriosis. Hum Reprod. 2014;29(3):400-12.
[35]Pierce SJ, Gazvani MR, Farquharson RG. Long-term use of gonadotropin-releasing hormone analogs and hormone replacement therapy in the management of endometriosis: A randomized trial with a 6 year follow-up. Fertil Steril. 2000;74(5):964-8.
[2]Whiteman MK, Kuklina E, Jamieson DJ, Hillis SD, Marchbanks PA. Inpatient hospitalization for gynecologic disorders in the United States. Am J Obstet Gynecol. 2010;202(6):541.e1-6.
[3]Mounsey AL, Wilgus A, Slawson DC. Diagnosis and management of endometriosis. Am Fam Physician. 2006;74(4):594-600.
[4]Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 1997;24(2):235-58.
[5]Practice bulletin NO. 114: Management of endometriosis. Obstet Gynecol. 2010;116(1):223-36.
[6]Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D'Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril. 2009;92(1):68-74.
[7]Armstrong C. ACOG updates guideline on diagnosis and treatment of endometriosis. Am Fam Physician. 2011;83(1):84-5.
[8]Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, et al. Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries. Fertil Steril. 2011;96(2):366-73e8.
[9]De Graaff AA, D'Hooghe TM, Dunselman GA, Dirksen CD, Hummelshoj L, Consortium WE, et al. The significant effect of endometriosis on physical, mental and social wellbeing: Results from an international cross-sectional survey. Hum Reprod. 2013;28(10):2677-85.
[10]Simoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I, et al. The burden of endometriosis: Costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod. 2012;27(5):1292-9.
[11]Saremi A. Treatment of endometriosis as a priority before art. Inte J Gynecol Obstet. 2000;70(1):A49.
[12]Roman H, Puscasiu L. Guidelines for the management of painful endometriosis. Chirurgia (Bucur). 2008;103(3):265-74.
[13]Leyland N, Casper R, Laberge P, Singh SS, Sogc. Endometriosis: Diagnosis and management. J Obstet Gynaecol Can. 2010;32(7 Suppl 2):S1-32.
[14]Wykes CB, Clark TJ, Khan KS. Accuracy of laparoscopy in the diagnosis of endometriosis: A systematic quantitative review. Int J Obstet Gynaecol. 2004;111(11):1204-12.
[15]Stratton P, Winkel C, Premkumar A, Chow C, Wilson J, Hearns Stokes R, et al. Diagnostic accuracy of laparoscopy, magnetic resonance imaging, and histopathologic examination for the detection of endometriosis. Fertil Steril. 2003;79(5):1078-85.
[16]Vercellini P, Trespidi L, Colombo A, Vendola N, Marchini M, Crosignani PG. A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis. Fertil Steril. 1993;60(1):75-9.
[17]Brown J, Pan A, Hart RJ. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev. 2010(12):CD008475.
[18]Hornstein MD, Yuzpe AA, Burry KA, Heinrichs LR, Buttram VL Jr, Orwoll ES. Prospective randomized double-blind trial of 3 versus 6 months of nafarelin therapy for endometriosis associated pelvic pain. Fertil Steril. 1995;63(5):955-62.
[19]Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev. 2004(3):CD003678.
[20]Revised American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67(5):817-21.
[21]Crosignani PG, Vercellini P, Biffignandi F, Costantini W, Cortesi I, Imparato E. Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis. Fertil Steril. 1996;66(5):706-11.
[22]Jacobson TZ, Duffy JM, Barlow D, Koninckx PR, Garry R. Laparoscopic surgery for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2009;1(4):CD001300.
[23]Sutton CJ, Ewen SP, Whitelaw N, Haines P. Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis. Fertil Steril. 1994;62(4):696-700.
[24]Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril. 2004;82(6):1633-7.
[25]Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: Cystectomy versus drainage and coagulation. Fertil Steril. 1998;70(6):1176-80.
[26]Mossa B, Ebano V, Tucci S, Rega C, Dolce E, Frega A, et al. Laparoscopic surgery for the management of ovarian endometriomas. Med Sci Monit. 2010;16(4):MT45-50.
[27]Al Kadri H, Hassan S, Al Fozan HM, Hajeer A. Hormone therapy for endometriosis and surgical menopause. Cochrane Database Syst Rev. 2009;1(1):CD005997.
[28]Abbott J, Hawe J, Hunter D, Holmes M, Finn P, Garry R. Laparoscopic excision of endometriosis: A randomized, placebo-controlled trial. Fertil Steril. 2004;82(4):878-84.
[29]Mahmood TA, Templeton A. The impact of treatment on the natural history of endometriosis. Hum Reprod. 1990;5(8):965-70.
[30]Crosignani PG, Luciano A, Ray A, Bergqvist A. Subcutaneous depot medroxyprogesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain. Hum Reprod. 2006;21(1):248-56.
[31]Guzick DS, Huang LS, Broadman BA, Nealon M, Hornstein MD. Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Fertil Steril. 2011;95(5):1568-73.
[32]Muzii L, Marana R, Caruana P, Mancuso S. The impact of preoperative gonadotropin-releasing hormone agonist treatment on laparoscopic excision of ovarian endometriotic cysts. Fertil Steril. 1996;65(6):1235-7.
[33]Hornstein MD, Hemmings R, Yuzpe AA, Heinrichs WL. Use of nafarelin versus placebo after reductive laparoscopic surgery for endometriosis. Fertil Steril. 1997;68(5):860-4.
[34]Dunselman GA, Vermeulen N, Becker C, Calhaz Jorge C, D'Hooghe T, De Bie B, et al. ESHRE guideline: Management of women with endometriosis. Hum Reprod. 2014;29(3):400-12.
[35]Pierce SJ, Gazvani MR, Farquharson RG. Long-term use of gonadotropin-releasing hormone analogs and hormone replacement therapy in the management of endometriosis: A randomized trial with a 6 year follow-up. Fertil Steril. 2000;74(5):964-8.