International Dexeus Forum - 44th edition
GINECOLOGY > ENDOMETRIOSIS
“Endometriosis: Failing to plan is planning to fail”
Pietro Santulli, Université Paris Descartes, Paris (France)
The respective advantages of surgery, medical treatment and ART intertwine complexly in women with endometriosis. The choice of the therapeutic options will depend on the clinical situation and the patient’s wishes, so, what is needed is that the women receive individualized care throughout their “endometriosis life”.
Endometriosis: Failing to plan is planning to fail
Endometriosis, histologically defined as functional endometrial glands and stroma developing outside of the uterine cavity is a common gynecologic disorder. Menstrual regurgitation and consecutive inflammation have a pivotal influence on the localizations of the lesions, and, together with environmental and genetic factors, may contribute to the development of endometriotic foci and its symptoms pain and/or infertility. Endometriosis is a heterogeneous disease with three phenotypes peritoneal superficial endometriosis (SUP), ovarian endometriosis (OMA) and deep infiltrating endometriosis (DIE). Adenomyosis (e.g. diffuse and/or focal) is frequently encountered in association with endometriosis.
Diagnosis of endometriosis and adenomyosis is based on questioning, physical examination and imaging (ultrasound and MRI, essentially). Diagnostic laparoscopy has been considered for a long time to be the gold standard for the diagnosis of endometriosis but is now out of date. A specific preoperative work up is required in order to plan, when decided, the best treatment. The choice of the therapeutic options (i.e., medical treatment; surgery; ART) will depend on the clinical situation and the patient’s wishes. In case of endometriosis, especially in case of deep endometriosis, surgery is not harmless and benefits of pain relief and spontaneous conception following surgery should be balanced with life threating surgical risk as fistula, peritonitis, bladder and intestinal dysfunctions and risk of disease recurrence. In addition in case of associated ovarian endometrioma, fears that surgery can alter ovarian function that is already compromised sparked a rule of no surgery before ART.
The respective advantages of surgery, medical treatment, and ART intertwine complexly in women with endometriosis. What is needed is that the women receive individualized care throughout their “endometriosis life”.