by: ASRM Office of Public Affairs
Published in ASRM Bulletin Volume 16, Number 15
Thursday, the Practice Committee will issue a new report on endometriosis- its treatment, incidence, and mechanism of associated pelvic pain.
Endometriosis - a condition in which the tissue lining the uterus develops outside of the uterine cavity in abnormal locations such as the ovaries, fallopian tubes, and abdominal cavity- is one of the most common gynecologic disorders and is found in 70% to 90% of female patients with pelvic pain. The evaluation and treatment of endometriosis are considered difficult because there is no standard method to measure pain; the mechanisms by which endometriosis causes pain are not completely understood; comparisons of the success of medical versus surgical treatments or placebo are difficult; endometriosis and associated pain may involve nearby organ systems beyond the reproductive tract; and pain attributed to endometriosis may have a true origin elsewhere.
Based on a comprehensive review of the literature on the disorder, the committee discussed the diagnosis of endometriosis, possible mechanisms of pain, and the appropriateness and effectiveness of different surgical and medical therapies, taking into account patients’ disease stage and reproductive plans.
Surgical therapies are discussed in detail, from laparoscopic procedures to removal of endometriotic cysts to hysterectomy. Medical therapies discussed range from nonsteriodal anti-inflammatory drugs to hormonal treatments, which may include progestins, gonadotropin releasing hormone agonists, contraceptive steroids, and aromatase inhibitors.
The committee also discussed additional treatments such as physical therapy to counter postural changes that may result from chronic pelvic pain, acupuncture, and counseling by a mental health professional to address the stress and depression that may be associated with extended suffering from pain.
They concluded that endometriosis should be viewed as a chronic disease. While further studies comparing medical and surgical treatment are needed, a life-long management plan should maximize the use of medical treatments and avoid repeated surgical procedures. Hysterectomy with removal of the ovaries should be reserved for women with debilitating symptoms reasonably attributed to the disease, who have completed childbearing and have not responded to less intensive treatments.
Linda Giudice, MD, PhD, Past President of ASRM, commented, “Endometriosis and pelvic pain affect millions of women in the US and worldwide. The disease can strike very early in a woman’s life, in her teens, and can last until menopause. The pain associated with endometriosis can be severe and debilitating, interfering with a woman’s work and relationships, drastically diminishing her quality of life, and potentially contributing to infertility. The Practice Committee’s new report on evaluating and treating endometriosis and pelvic pain distills our current knowledge into a detailed guidance that will be valuable to all women’s healthcare providers.”
Rebecca Sokol, MD, MPH, Acting President of ASRM, added, “ASRM is very proud to be a co-sponsor of the worldwide March for Endometriosis 2014. We invite everyone to join us in showing their support for the women who are suffering from this disease. We hope this event draws more attention to the need for more research into the causes and treatment of endometriosis.”
The Practice Committee of the American Society for Reproductive Medicine, Treatment of Pelvic Pain Associated with Endometriosis, Fertility and Sterility, in press.
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