Conservative treatment of deep infiltrating endometriosis: review of existing options.
Maria SzubertMagdalena ZiętaraJacek SuzinPublished in: Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology (2017)
Endometriosis with its estimated incidence rate of ∼7-10% of women of reproductive age is a disease with the wide spectrum of symptoms depending on form and localization of endometrial foci. One clinical form of endometriosis is deep infiltrating endometriosis (DIE), most difficult to manage and generating a lot of direct and indirect treatment costs. We search the literature from PubMed database to establish the role of conservative treatment of DIE. Randomised controlled trials are lacking but in experts opinion hormonal treatment should be the first-line treatment in DIE. After evaluation of pain or other symptoms, second-line therapy with GnRH analogs or danazol should be offered or minimally invasive surgery. Consensus is not made whether surgery is the best therapeutic treatment for affected patients. Strong depending on surgeon's experience conservative surgery should be offered if the total excision of DIE foci is possible, which is essential for a successful outcome. If available treatment options do not release pain associated with DIE, experimental treatment in clinical trials should be discussed with patients.
Keyphrases
- clinical trial
- systematic review
- emergency department
- randomized controlled trial
- newly diagnosed
- pregnant women
- pain management
- ejection fraction
- mesenchymal stem cells
- metabolic syndrome
- bone marrow
- atrial fibrillation
- percutaneous coronary intervention
- depressive symptoms
- polycystic ovary syndrome
- adipose tissue
- combination therapy
- acute coronary syndrome
- molecular dynamics simulations
- insulin resistance
- patient reported
- open label
- double blind
- drug induced
- placebo controlled