1. Endometriosis :
An Overview
DR .NAMITHA KAPOOR
Dr. Sharda Jain
Dr. Jyoti Agarwal
Dr. Jyoti Bhaskar

2. •Diagnostic Dilemma
•Debilitating Disease
•Progressive Disease
•Disease with “No Cure”
• A Gynaecologist’s dilemma

3. PREVALENCE
•10%
Prevalence is higher in women with
• Dysmenorrhea : upto 60%
• Dyspareunia : upto 44%
• Pelvic Pain : upto 80%

4. Symptoms
Infertility 40 % Dysmenorrhoea 60 %
Chronic
Pelvic
Pain 80%
Pain
Premenstrual
Intramenstrual
Postmenstrual
100%
Dyspareunia 45 %

5. Pathogenesis ??
Endometriosis is said to be
Estrogen dependent .
It is one of the major causative
factors in the development of
endometriosis.

6. Excess Estrogen stimulates
Inflammation
Invasion
Angiogenesis
Cell Proliferation
Adhesions Pain

7. Treatment
Achieve Reduced
Estrogenic State
(Short of Hypoestrogenism)

8. Current Treatment options
SURGICAL MEDICAL
Removal of
Superfical and
Deep lesions
Adhesiolysis
To destroy or
prevent the lesions
( Not Possible)
Removal of
Chocolate cysts

9. When is medical treatment
required
• First line treatment with chocolate cyst?
• First line treatment with superficial / deep
nodules?
• Role before surgery ?
• After surgery to prevent recurrence ?
• When surgery is not possible or refused ?
Full of
controversies
?

10. Limitations of surgery
Skill
High risk of recurrence after surgery
25 % recurrence after 2 years
50 % at 5 years
40 – 80 % women have PAIN again within
2 years of surgery

11. Medication Limitation
NSAIDs Lack of supporting evidence from controlled trials
GI side effects
Risk of gastric ulceration
Anti-ovulatory effect, when taken at mid cycle
Combined Oral Not approved for endomteriosis in most countries
Contraceptives Break through bleeding
GnRH Agonist Causes hot flushes, vaginal dryness and decreased libido
(Leuprolide) Acceleration of bone mass loss; increased risk of
osteoporosis
Use is limited upto 6 months
Androgens Adverse effect on lipid metabolism
(Danazol) Causes acne, Hirsuitism, vaginal dryness, edema, hot
flushes.
Associated with liver toxicity and breast atrophy
Progestins Lack of supporting evidence from controlled trials
Lack of dose finding data
Adverse impact on BMD

12. ESHRE guidelines states
“Progestin can be considered
as a first choice for the
treatment of endometriosis”

13. ESHRE
guidelines
2014
Best so far
Will answer all your queries

14. March
is
Endometriosis
Awareness
Month

15. ADDRESS
11 Gagan Vihar, Near Karkari
Morh Flyover, Delhi - 51
Helpline
9650588339,
011-22414049, 011-22058865
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
E-MAIL ID
Sharda.lifecare@gmail.com
Lifecarecentre21@gmail.com
info@lifecareivf.com
&

16. THANK YOU