Clinical Focus on Endometriosis Jaideep Malhotra, Rohan Palshetkar, Narendra Malhotra, Neharika Malhotra, Aruna Suman, Panchampreet Kaur, Kalyan B Barmade
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table
Adnexa 30
American Association of Gynecologic Laparoscopists 6, 24
classification 12, 12f
American Society for Reproductive Medicine 7, 8t, 16, 21, 21f, 44, 60, 68
revised classification of endometriosis 7, 8t
Angiogenesis 18
Anti-Müllerian hormone 53
Aromatase inhibitors 37, 51
Assisted reproductive technology 44, 47, 60, 68
indications for 54
Atorvastatin 58
Autoantibodies 18
Bladder 24, 30
anterior compartments of 32f
endometriosis 16
posterior compartments of 32f
Blood biomarkers 18
Bone mineral density 77
Bowel 30
Brain-derived neurotrophic factor 68
Cabergoline 38, 58
antigen 3, 18
benign 1
ovarian 1, 2fc
Cervix 30
Clomiphene citrate 62,63,63t, 64, 65
Coelomic metaplasia 7
Computed tomography scan 20
Conservative surgery, outcomes of 42
Controlled ovarian
hyperstimulation 60
stimulation 61
C-reactive protein 18
Cyst, endometriotic 19f, 20f
Cystectomy 41
laparoscopic 52
Cytokines, inflammatory 18
Danazol 37, 51
Deep infiltrating endometriosis 15, 26, 29, 52f, 53
Enzian classification of 27f
Deoxyribonucleic acid 1
Diarrhea 47
Dienogest 51
Douglas pouch 17, 29, 30
Dyschezia 28, 47
Dysmenorrhea 28, 47, 75
Dyspareunia 28, 47, 75
Dysuria 28, 47
Embryo transfer 67
Endocrine abnormalities 47
Endometrial stromal tissue 19
Endometrioma 15, 21, 30, 52f
Endometriosis 1, 2fc, 6, 12f, 15, 17, 24, 25f, 36, 44, 47, 48f, 52, 53, 57, 58, 60, 67, 68f, 69, 75
bowel deep infiltrating 33f
classification for 47, 49f
deep 7, 24, 28, 41
infiltrating 15, 26, 29, 52f, 53
development 45
diagnosis of 17, 22, 24
enigma 1
Enzian classification of 11f
epidemiology of 46f
fertility index 7, 26, 48, 70, 74
classification 9t, 10t
lesions, evolution of 2fc
malignant transformation of 1
medical management of 36
mild 60, 63
mild to moderate 61f
minimal 60, 63
moderate 60
ovarian 7, 24, 41
pathogenesis of 45, 45f
pelvic 67
peritoneal 41
premenarchal 6
recurrent 75, 76, 77t, 78f
Research Foundation 27f
revised classification of 21f, 25f
scoring systems 24
severe 60
staging for 47, 49f
superficial 24, 28, 52f
surgical management of 40
symptoms of 47, 47t
therapy 51
treatments for 74fc
Endometrium 47, 62
Enzian classification 7, 11f, 12, 26, 27f
revised 9
Epiphenomenon 1
Epithelial cells 57
Estradiol 63
Estrogen receptor 77
European Society for Gynaecological Endoscopy 6, 24
European Society of Human Reproduction and Embryology 6, 17, 24, 41, 44, 60
guidelines 70
Federation of Obstetric and Gynaecological Societies of India 44
Fibroblast growth factor-2 188
Follicle-stimulating hormone 6264, 71
Follicular fluid 68
Follistatin 18
Frozen embryo transfer 53
Genetics 7
Glycodelin A 18
Glycoproteins 18
Gonadotropin-releasing hormone 38, 41, 70
agonists 37, 51, 61
antagonists 38
Hematochezia 28, 47
Hematuria 28
macroscopic 47
microscopic 47
Heme 1
Hemoglobin, extracellular 1
growth factor 18
nuclear factor 1-beta 2
Human chorionic gonadotropin 61
Human endometrial stromal cells 58
Human menopausal gonadotropin 62, 64
Hysterectomy 42
In vitro fertilization 26, 52, 62, 67
Infertility 47, 60
endometriosis-related 48
male 54
Inflammatory disease 6
International deep endometriosis analysis 28
International ovarian tumor analysis 29, 30
Intracytoplasmic sperm injection 71
Intrauterine insemination 53, 60, 63
clinical impact 65
protocols 60
Iron 1
Kirsten rat sarcoma viral oncogene homolog 2
Laparoscopic uterine nerve ablation 42
Laparoscopy 20, 28
surgery 40
Lesions, endometriotic 15
Letrozole 62, 63t
Leuprolide acetate 37
Levonorgestrel-releasing intrauterine system 80
Lovastatin 58
Luteinizing hormone 61, 63, 68
Magnetic resonance imaging 19, 26
Malignancy, endometriosis-associated 1
Malignant transformation
early detection of 3
mechanism of 1, 2fc
Matrix metalloproteinases 46
Menstrual pain, severe 47
Menstrual stem cells 57
Mesenchymal epithelial transition factor 2
Microembolization 6
Mifepristone 37
Monocyte chemoattractant protein-1 18
Morphological uterus sonographic assessment 30
Multidetector computerized tomography enema 26
Nafarelin 37
National Institute for Health and Care Excellence 61
Nonsteroidal anti-inflammatory drugs 37, 78
Nuclear factor kappa B 46
donation 70
quality of 69t
Oophorectomy 42
Oral contraceptive
combined 36, 51, 74
low-dose 80
pills 77, 81
Ovarian cancer pathogenesis, endometriosis-associated 2fc
Ovarian clear cell cancer 3
Ovarian endometrioma 15, 28, 29, 41, 52
size of 30
Ovarian endometriosis 7, 24, 41
cysts 21
Ovarian hyperstimulation syndrome 65, 74
Ovarian masses 30
Ovarian suppression 51
Ovulatory dysfunction 69
Pelvic adhesions 20f
Pelvic nerve pathways, interruption of 42
Pelvic pain, chronic 28, 47, 75
Phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha 2
Platelet-derived growth factor 18
Pollakiuria 47
Pregnancy 76
Presacral neurectomy 42
Progesterone-containing contraceptives 36
Progestins 51
Proteomics 19
Radical surgery 42
Randomized controlled trial 51, 71
Rapamycin, mammalian target of 2
Reactive oxygen species 46
Rectosigmoid junction 30, 31
Rectovaginal nodules 31
Rectovaginal septum 9, 30, 31
Rectum 24, 30, 31
Retrograde menstruation, Sampson's theory of 6
Revised American Society for Reproductive Medicine 7, 26
classification 7
Sampson's theory 6
Selective estrogen receptor modulators 51
Selective progesterone receptor modulators 37
Sigmoid 31
colon 30
Simvastatin 58
Society of Obstetricians and Gynaecologists of Canada 44
Soluble epidermal growth factor 18
Sorafenib 58
Stem cell 3, 57, 58
therapy 57, 58
Steroidogenesis 67
Superficial peritoneal lesions 15
Superovulation 53
Tenesmus 47
Transvaginal scan 19
Transvaginal sonography 26
Tubal factor 69
Tuboovarian complex 10
Tumor necrosis factor alpha 46, 60
Ulipristal acetate 37
Ultrasound 19
Ureteric lesions 41
Ureters 30
Urine biomarkers 19
Uterine adenomyosis 16
Uterosacral ligaments 24, 30, 31
Uterovesical region 30
Uterus 30, 57
anteverted 31f
retroverted 31f
Vagina 24
Vaginal fornix, posterior 30
Vaginal septum 9
Vaginal wall 31
Vascular endothelial growth factor 18, 46, 60
World Endometriosis Society 24, 44
Zona pellucida 68f
Chapter Notes

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Clinical Focus on Endometriosis
Clinical Focus on Endometriosis
Series Editors Neharika Malhotra MD (Gold Medalist) DRM (Germany) FICMCH Fellow ICOG (Rep Med) ICOG (USG) Director and Consultant ART Rainbow IVF and MNMH (P) Ltd and Ujala Cygnus Rainbow Hospital Agra, Uttar Pradesh, India Joint Secretary, FOGSI Chair, YTP Committee, FOGSI Jaideep Malhotra MD FICMCH FICOG FRCOG FRCPI FMAS Managing Director ART Rainbow IVF and MNMH (P) Ltd and Ujala Cygnus Rainbow Hospital Agra, Uttar Pradesh, India President, SAFOM/ISPAT Past President, IMS/ISAR/FOGSI/ASPIRE Narendra Malhotra MD FICMCH FICOG FRCOG FICS FMAS FIAP Managing Director Global Rainbow Health Care and MNMH (P) Ltd and Ujala Cygnus Rainbow Hospital Agra, Uttar Pradesh, India Professor, Sarajevo School of Science and Technology, Croatia Past President, FOGSI/IFUMB/ISPAT/ISAR, INSARG Vice President, WAPM/SAFOG Director, International IAN Donald School and SAFOG Editors Aruna Suman MD FICOG Professor and Head Department of Obstetrics and Gynecology Government Medical College Hyderabad, Telangana, India Rohan Palshetkar MS (Obs and Gyne) FRM BDRME ADRME Associate Professor Head of Unit Bloom IVF Mumbai, Maharashtra, India Panchampreet Kaur DGO DNB MNAMS FICMCH Assistant Professor Obstetrics and Gynecology Lady Hardinge Medical College and Smt SK Hospital New Delhi, India Kalyan B Barmade DNB FCPS DGO DFP Consultant, Gynec Endoscopic Surgeon and IVF Specialists Director, Department of Obstetrics and Gynecology Latur Fertility Center Pvt Ltd Latur, Maharashtra, India Foreword Nandita Palshetkar
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Clinical Focus on Endometriosis
First Edition: 2024
Printed at:
Our parents, teachers, and all practicing obstetricians and gynecologists
Contributors Foreword
Dear Readers,
Endometriosis is a condition that affects millions of individuals around the world, yet it remains widely misunderstood and often overlooked. As a gynecologist who has treated thousands of cases of endometriosis it is a pleasure to see the Series Editors Dr Neharika Malhotra, Dr Jaideep Malhotra, and Dr Narendra Malhotra along with the Editors of this book, Dr Aruna Suman, Dr Panchampreet Kaur, Dr Rohan Palshetkar, and Dr Kalyan B Barmade release this Endometriosis Focus.
As someone who has personally witnessed the physical and emotional toll that endometriosis can take on individuals, I am deeply grateful for the dedication and passion of the authors in bringing this book to life. Their commitment to raising awareness and offering guidance is evident on every page.
You will find a comprehensive exploration of endometriosis, from its mysterious origins to the latest advancements in diagnosis and treatment. The authors have put in extensive research and come with latest advances to update you with current trends in the management of endometriosis. This book provides a wealth of knowledge and I am sure you are going to have a fantastic read.
The book is going to be an in-depth dive into the challenges that we face in endometriosis and a call to action for all of us to work together in eliminating this enigmatic disease. I hope this book helps you in your day-to-day practice and you are able to apply the knowledge you gain to better the care you can provide to your patients.
Happy reading
Nandita Palshetkar
Medical Director, Bloom IVF-India
Mumbai, Maharashtra, India
President, ISAR (2022–24)
Past President, FOGSI, IAGE, AMOGS, MOGS
FOGSI Representative to FIGO
The editors of this Clinical Focus on Endometriosis have worked hard to get a ready-reckoner for all practicing obstetricians and gynecologists. This book is a compilation of chapters to help the readers manage endometriosis easily and confidently. Each chapter has been immaculately formulated to present working knowledge of the latest management protocols. The chapter contributors have put the complex problem of endometriosis in simple format which can be read easily and understood by all. We sincerely hope that the readers will find this book very useful to students, teachers, and practitioners.
“Reading is the gateway skill the makes all other learning possible.”
Neharika Malhotra
Jaideep Malhotra
Narendra Malhotra
We have the pleasure of introducing Clinical Focus on Endometriosis.
We thank the Almighty God for helping us throughout the journey of completing this task. Our heartfelt gratitude to Dr Nandita Palshetkar for accepting to write the foreword for this book and also give her blessings.
It is with utmost pleasure that we thank Dr Narendra Malhotra, Dr Jaideep Malhotra and Dr Neharika Malhotra, our mentors and guide for this clinical series, who lent their considerable clinical and academic prowess.
We wish to thank all our contributors who responded to our requests with promptness. Our heartfelt thanks to them. We wish to appreciate the efforts of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for bringing out this book in its final shape with their talent of skillfully and expediently coordinating and overseeing composition. We also thank publishing team of M/s Jaypee Brothers Medical Publishers, especially Ms Pallavi A Mehrotra. Without the thoughtful, creative efforts of many, our Focus Series would have been a barren wasteland of words. Their attention to detail and accurate renderings added important academic support to our words.
Our special appreciation and thanks to all our colleagues and friends who supported our idea of bringing out this series and gave us the confidence to finish this book. Lastly, we offer an enthusiastic thanks to our families and friends. We sincerely thank you for your love and support which kept us going to finish this work of ours.
Aruna Suman
Panchampreet Kaur
Rohan Palshetkar
Kalyan B Barmade