Sites of EndometriosisSites of Endometriosis

A dark endometrial implant A dark endometrial implant in the vaginal wall.in the vaginal wall.

Implants of endometriosis Implants of endometriosis on the surface of the ovaryon the surface of the ovary

Ovarian Ovarian endometriomaendometrioma

Generally used to confirm Generally used to confirm diagnosis – hallmarks of the diagnosis – hallmarks of the disease are disease are peritoneal or peritoneal or retroperitonealretroperitoneal implants, implants, adhesionsadhesions and and endometriomasendometriomas

Lesions may be seen:Lesions may be seen: typical:typical: pigmented, dark, pigmented, dark,

powder-burn nodulespowder-burn nodulesatypical:atypical: non-pigmented, non-pigmented,

clear, white, red flame-like, clear, white, red flame-like, yellow-brown nodulesyellow-brown nodules

Diagnosis (3) - LaparoscopyDiagnosis (3) - Laparoscopy

Diagnosis (3a) LaparoscopyDiagnosis (3a) Laparoscopy

Patient APatient A

Characteristic powder-Characteristic powder-burn lesion viewed on the burn lesion viewed on the surface of the uterus using surface of the uterus using laparoscopylaparoscopy

Diagnosis (3b) LaparoscopyDiagnosis (3b) Laparoscopy

Patient BPatient B

Ovary and fallopian Ovary and fallopian tube identifiable in this tube identifiable in this laparoscopy imagelaparoscopy image

Diagnosis (3c) LaparoscopyDiagnosis (3c) Laparoscopy

Patient CPatient C

Flame-like lesion Flame-like lesion viewed on the surface viewed on the surface of the uterus using of the uterus using laparoscopylaparoscopy

Implants on the surface Implants on the surface of the peritoneumof the peritoneum

Ovarian endometriomaOvarian endometrioma

Lesions in the pouch of Lesions in the pouch of DouglasDouglas

Hormonal TherapyHormonal Therapy

GnRH agonistsGnRH agonistsDecapeptylDecapeptyl®®

Mode of actionMode of action SuppressionSuppression of the of the

hypothalamic-pituitary hypothalamic-pituitary gonad axisgonad axis

‘‘Starving’Starving’ of the of the endometrial tissue by endometrial tissue by blocking oestrogen blocking oestrogen and progesteroneand progesterone

Hormonal TherapyHormonal TherapyGnRH agonists - DecapeptylGnRH agonists - Decapeptyl®®

EfficacyEfficacy Relief of pain in approx. Relief of pain in approx. 90 % o90 % of all patientsf all patients

A comparative trial (triptorelin vs placebo) from A comparative trial (triptorelin vs placebo) from Bergquist Bergquist et al.,et al.,1998 confirmed that this is due to1998 confirmed that this is due tothe action of Decapeptylthe action of Decapeptyl®®DepotDepot

Reduction of the size of endometriomas Reduction of the size of endometriomas by by 50 % within 3 months50 % within 3 months

beforebefore afterafter

Add-back therapy: RationaleAdd-back therapy: Rationale

Oes

trad

iol

Oes

trad

iol Decrease of endometriosis symptomsDecrease of endometriosis symptoms

Increase of menopausal symptomsIncrease of menopausal symptoms

GnRHaGnRHa

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