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Manual of Endometriosis
Kanthi Bansal
CHAPTER 1:
Endometriosis: Evolution
INTRODUCTION
Evolution in Pathogenesis of Endometriosis
Evolution in Clinical Presentations and Diagnosis
Peritoneal Endometriosis
Rectovaginal Endometriosis
Ovarian Endometriosis
Evolution in Treatment
Medical Treatment
Surgical Treatment
CONCLUSION
CHAPTER 2:
Endometriosis: Structure to Function
INTRODUCTION
PHYSIOLOGICAL ANATOMY
The Uterine Cycle
The Ovarian Hormones Drive the Morphological and Functional Changes of the Endometrium During the Monthly Cycle
Etiopathophysiology
Etiology
Trauma or Surgery
PATHOPHYSIOLOGY
CHAPTER 3:
Diagnostic Modalities of Endometriosis and their Pitfalls
INTRODUCTION
HISTORY
PATHOLOGY
EPIDEMIOLOGY
CLINICAL FEATURES
DIAGNOSTIC EVALUATION
Clinical Evaluation
Pitfalls of a Clinical Diagnosis
Diagnosis by Therapeutic Trial
Pitfalls of a Therapeutic Trial—Retrospective Diagnosis
Surgical Evaluation
A. Endometrial Tissue Biomarkers
B. Laparoscopic Peritoneal Cavity Assessment
Pitfalls of a surgical diagnosis
C. Peripheral Biomarkers16,31
D. Radiological Evaluation
Adnexal endometriotic cysts-endometriomas (Figs 3.5A to C):
Rectovaginal endometriotic nodules and deep infiltrating endometriosis of the uterosacral ligaments.
CONCLUSION
CHAPTER 4:
Ovarian Endometrioma: Diagnosis and Management
INTRODUCTION
PATHOGENESIS OF OVARIAN ENDOMETRIOMAS
CLINICAL PRESENTATION AND DIAGNOSIS OF ENDOMETRIOMA
MANAGEMENT OF ENDOMETRIOMA
SURGICAL TREATMENT OF ENDOMETRIOMA
Surgical Approach
Laparoscopic Technique
Complications and Safety Aspects
Role of Adjunctive Surgical Procedures
Hormonal Treatment before and after Surgery
Management of Endometrioma in Women with Pelvic Pain
OOPHORECTOMY FOR ENDOMETRIOMA
OVARIAN ENDOMETRIOMA: EFFECT ON FERTILITY AND ITS MANAGEMENT
Management of Endometrioma Prior to IVF
Management of Women with Asymptomatic Endometrioma
ENDOMETRIOMA EXCISION AND OVARIAN RESERVE
ULTRASOUND-GUIDED ASPIRATION OF ENDOMETRIOMA
SCLEROTHERAPY FOR ENDOMETRIOMA
RECURRENT ENDOMETRIOMA AND ITS MANAGEMENT
ENDOMETRIOMA AND OVARIAN CANCER
CONCLUSION
CHAPTER 5:
Endometriosis and Infertility
PATHOGENESIS
APPROACH TO A PATIENT
MEDICAL MANAGEMENT
SURGICAL MANAGEMENT
Clinical Tips
ROLE OF SURGERY BEFORE IVF
ASSISTED REPRODUCTION
Controlled Ovarian Stimulation and IUI
IVF
Clinical Tips
CHAPTER 6:
Endometriosis in Adolescent
INTRODUCTION
Geographic Incidence
PREVALENCE
Presentation
DIAGNOSIS
MANAGEMENT
SUMMARY STATEMENTS
Clinical Tip
Recommendations
CHAPTER 7:
Adenomyosis an Enigma
PATHOLOGY
Symptoms
Diagnosis
Ultrasound
MRI
Management
Steps of Laparoscopic Excision of Adenomyoma
CHAPTER 8:
Medical Management of Endometriosis
INTRODUCTION
TREATMENT
MEDICAL THERAPY
Nonsteroidal Anti-inflammatory Agent (NSAID)
GNRH ANALOGS
COMBINED ORAL CONTRACEPTIVES
PROGESTOGENS
PROGESTERONE RECEPTOR ANTAGONISTS
DANAZOL
GESTRINONE
INTERFERONS
CONCLUSION
CHAPTER 9:
GnRH Agonists in Endometriosis
INTRODUCTION
GNRH AGONISTS AS A TREATMENT FOR ENDOMETRIOSIS
Mechanism of Action
DOSE AND ADMINISTRATION
EFFECTIVENESS
For Pain
Use before Surgery
Use after Surgery
Use in Recurrent Endometriosis
Role of Surgery Versus GnRH Agonist
Role of GnRH Agonists in IVF
SIDE EFFECTS
Menopausal-Type Symptoms
Osteoporosis
CONCLUSION
CHAPTER 10:
Surgical Management of Endometriosis
INTRODUCTION
PERITONEAL DISEASE
OVARIAN DISEASE
PELVIC DENERVATION
Does Hysterectomy with Bilateral Oophorectomy have a Role Today?
Endometriosis of the Bowel and Bladder
CONCLUSION
CHAPTER 11:
Pain Management in Endometriosis
ASSESSMENT OF THE CAUSE OF PAIN IN WOMEN WITH PELVIC PAIN
History
Examination
Investigation
Treatment of Pelvic Pain
Drugs for Pain Relief
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Side Effects
Antiprogestins
Effects
Oral Contraceptives
Side Effects
Danazol
Gestrinone
Aromatase Inhibitors
GnRH Agonists
Supplements for Pain Relief
DEPOT PROGESTIN THERAPY
Immunotherapy
TENS FOR PAIN RELIEF
Massage
Aromatherapy
Acupuncture
Yoga and Pain Management
Menastil
DLPA
INTENDED USES
Arnica Gel and Cream
MSM for Pain Relief
Exercise
Treatment of Dysmenorrhea on Day 1 to 2 of the Menstrual Cycle
Treatment of Prolonged Dysmenorrhea
Treatment of Ovulation Pain
Treatment of Pelvic Pain and Bladder Symptoms
Treatment of Sharp and Stabbing Pains
Treatment of Diagnose the Cause of Dyspareunia
Treatment of Painful Vulva (Vulvodynia)
Treatment of Painful Pelvic Muscles
Common Barriers to Effective Pain Management
Dysmenorrhea, Pelvic Pain and Endometriosis
Points to Ponder
Surgical Intervention
Surgical Technique
Laparoscopic Uterosacral Nerve Ablation
Presacral Neurectomy
MEDICAL THERAPY FOLLOWING CONSERVATIVE SURGERY FOR ENDOMETRIOSIS
LONG-TERM MANAGEMENT
SUMMARY AND CONCLUSION
CHAPTER 12:
Recurrent Endometriosis: Clinicians Challenge
PREVALENCE OF RECURRENCE
CAUSES OF RECURRENCE
Diagnosis of Recurrent Endometriosis
Laparoscopy
Imaging Tests
Biomarkers for Recurrence
Management of Recurrent Endometriosis
Surgical Management
POSTOPERATIVE MEDICAL MANAGEMENT IN RECURRENT ENDOMETRIOSIS
Medical Management of Recurrent Endometriosis
Infertility Due to Recurrent Endometriosis
Control of Recurrence of Endometriosis
SUMMARY
CHAPTER 13:
Scar Endometriosis
INTRODUCTION
INCIDENCE
ETIOPATHOGENESIS OF SCAR ENDOMETRIOSIS
Histology of Endometriosis
Sites of Scar Endometriosis
Clinical Presentation
Diagnosis of Scar Endometriosis
Differential Diagnosis
MANAGEMENT OF SCAR ENDOMETRIOSIS
Medical Management
Surgical Management
Malignant Risk following Scar Endometriosis
FOLLOW-UP AND PREVENTION OF SCAR ENDOMETRIOSIS
Case 1
Case 2 and 3
Case 4
Case 5 and 6
Case 7
Case 8
CONCLUSION
CHAPTER 14:
Rectovaginal Endometriosis: A Distinct Entity
INTRODUCTION
DEFINITION
INCIDENCE
Etiology
Symptoms
Staging
DIAGNOSIS
Physical Examination
Transvaginal Ultrasonography
Transvaginal Tenderness Guided Ultrasonography2
RWC-TVS
Rectal Endoscopic Ultrasonography (RES)
Magnetic Resonance Imaging (MRI)
Sonovaginography6
Introital Three-dimensional (3D) Transvaginal Sonography (US)10
Colonoscopy
Multislice Computed Tomography Enteroclysis (MSCTe)4
Rectal Involvement
Surgically
HISTOLOGY
TREATMENT
Medical
Progestogens and Estrogen-Progestogen
Progestogens
Danazol
Levonorgestrel-Releasing Intrauterine Device (LNG-IUD)
Gonadotrophin-Releasing Hormone Agonist (GnRH Agonist)
Aromatase Inhibitors
Surgical
Surgical Treatment of RVE
Role of Robotics
Important Facts Regarding Surgical Management
Complications
FERTILITY AND RVE
CHAPTER 15:
Coping Up with Endometriosis
INTRODUCTION
ENDOMETRIOSIS: AN ENIGMA
The Impact of Endometriosis
DIAGNOSIS
How to Cope with Endometriosis?
Some Coping Tips
CONCLUSION
CHAPTER 16:
Recent Advances of Treatment in Endometriosis
INTRODUCTION
TREATMENT OF ENDOMETRIOSIS ASSOCIATED PAIN
Nonsteroidal Anti-inflammatory Drugs
Hormonal Treatment
NEWER TREATMENT MODALITIES
SURGICAL TREATMENT
Role of Surgery in Adolescents
SURGERY IN REPRODUCTIVE AGE GROUP
Surgical Treatment for Endometriosis Associated Pain
Peritoneal Lesions
Ovarian Endometrioma
Moderate to Severe Degree of Endometriosis
TREATMENT OF ENDOMETRIOSIS RELATED SUBFERTILITY
ASSISTED REPRODUCTION IN ENDOMETRIOSIS
EXTRA GENITAL ENDOMETRIOSIS
COMPLEMENTARY THERAPY
Nutritional Therapy/Dietary Modification
Homeopathy
Herbal Remedies/Traditional Chinese Medicine
Exercise
CHAPTER 17:
Endometriosis: Future Thoughts
DIAGNOSIS OF ENDOMETRIOSIS
Biochemical Methods
Endometrial Histology
THERAPY FOR ENDOMETRIOSIS
Antiestrogen Therapies: COC, Progesterones, Danazol, Gestrinone
Gonadotropin-Releasing Hormone Agonists (GnRHa)
Oral GnRH Antagonists
Diet, Habitus and Alternative Therapies
Chinese Herbal Medicines (CHM)
CHM vs Gestrinone
CHM vs Danazol
Aromatase Inhibitors
Lipiodol Flushing
Photodynamic Therapy (PDT)
SERMs and SPRMs
Terbutaline
Mifepristone (RU-486)
Angiogenesis (Stopping the Lesion at its Source)
Endocrine Disrupters
Iron Chelators
INDEX
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Index
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