TRATAMIENTO de la ENDOMETRIOSIS: analgésicos, anticonceptivos, cirugía.. - Ginecología y Obstetricia

Dr. Melgar summarizes the treatment for endometriosis. More information at ....... AULAGINECOLOGIA.COM ENDOMETRIOSIS TREATMENT As we mentioned the other day, endometriosis is a chronic condition, and therefore, the treatment we provide must be long-term. MEDICAL TREATMENT Medical treatment includes: Analgesics Hormonal contraceptives GnRH analogues MODELARATE-MODERATE PAIN In these cases, the first-line treatment will be NSAIDs and hormonal contraceptives (both can be combined). This treatment will be effective in most cases, especially in patients in whom large endometriotic implants have not been identified. Furthermore, it is a low-risk treatment. We can use it both in patients diagnosed with endometriosis and in patients with chronic pelvic pain such as dysmenorrhea (even if endometriotic implants are not visible). SEVERE PAIN When the pain is severe, we will consider treatment with GnRH analogs (for example, triptorelin). The mechanism of action of agonist analogs is by binding to GnRH receptors in the anterior pituitary gland, permanently blocking them (instead of the usual pulses of the endogenous hormone). This leads to suppression of the pituitary-gonadal axis, resulting in hypoestrogenism. With this, we mimic a reversible menopause, which will cause amenorrhea and endometrial atrophy. We try to alleviate the pain, but we will also experience numerous side effects derived from estrogen suppression: hot flashes, vaginal dryness, decreased libido, mood swings, headaches, and decreased bone mineralization. SURGICAL TREATMENT When treatment does not respond to medical treatment, we consider performing an exploratory laparoscopy, which will also provide an opportunity to treat the disease. The goal is to improve pain by removing endometriotic implants, resolving endometriomas, and releasing adhesions. PATIENTS WITH INFERTILITY In these patients, we can only offer treatment with analgesics or surgical treatment if appropriate. In some cases, it may be necessary to refer patients to specific reproductive units. ENDOMETRIOMA In women with endometriomas, we aim to reduce pain and symptoms resulting from the mass effect, as well as complications such as rupture, torsion, or infection. Surgery can also be used to exclude malignancy, improve ovarian function, and improve subfertility. DEEP ENDOMETRIOSISIS In asymptomatic women, we will not provide any treatment. For those with symptoms, we will begin by offering medical treatment. We will offer surgery when there is intestinal or ureteral obstruction. EXTRAGENITAL AFFECTATION When there are implants outside the genital tract, such as implants in the rib cage that cause hemothorax, complications will be treated, and medical treatment, often with GnRH analogues, must be added. CHRONIC PELVIC PAIN In patients with chronic pelvic pain, even if endometriosis is not diagnosed (due to lack of histological confirmation or because imaging tests fail to detect it), treatment with analgesics and hormonal contraceptives can be offered. OTHER THERAPIES As we discussed in the section on dysmenorrhea (see video), there are alternative therapies. Regarding acupuncture, there is only one study of sufficient quality to be evaluated, and it concludes that auricular acupuncture is superior to Chinese herbal treatments in patients with dysmenorrhea and endometriosis. Regarding diet, no diet has been shown to be superior to others in the treatment or prevention of endometriosis. However, it has been shown that women who consume more green vegetables and fruit have a lower risk of endometriosis and dysmenorrhea. It is also known that diets rich in red meat carry a slightly higher risk of endometriosis. No association has been demonstrated between endometriosis and coffee, alcohol, fish, or dairy products. (See video on dysmenorrhea.) SUMMARY INFORMATION: Endometriosis for PATIENTS:    • ENDOMETRIOSIS (PACIENTES): Síntomas, diagn...   Related Topics: Endometriosis:    • ENDOMETRIOSIS I: patogenia, síntomas y dia...   Dysmenorrhea:    • DISMENORREA o DOLOR DE REGLA: causas, diag...   Pelvic Inflammatory Disease (PID):    • ENFERMEDAD INFLAMATORIA PÉLVICA (EPI) PACI...   Fibroids:    • MIOMAS: Síntomas, diagnóstico y tratamient...   Polyps:    • PÓLIPOS UTERINOS: Causas, riesgo de cáncer...   More information, videos, podcasts, and PDFs at aulaginecologia.com