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Re: endometriosisFrom: George M. Grunert (grunert@ICSI.Net)Thu Aug 27 16:59:33 1998
> Give me an advice. > > I have a 16 years old patient who has been diagnosed endometriosis, > stage IV(score 42). She complained severe pain on her whole abdomen > while she was menstruating and visited via ER, one week ago. Ovarian > cyst(dermoid in nature on sonography) torsion was suspected, so > pelviscopy was done in order to remove that. But, I found severe > adhesion between both ovaries and uterosacral ligaments and posterior > uterine portion. The ovarian cyst was not present, maybe we was mixed up > on the ovary and some fluid filled space made by adhesion. > > I couldn't decide how to start treating her. I'd like to get some > information to be concered with treatment or follow-up in the similar > case as mine. 1. Make certain this is endometriosis. Did she have a biopsy done at laparoscopy, or did the adhesions preclude an accurate diagnosis? If not, you can still pre-treat her, but at some point a histologic diagnosis is mandatory in this patient. 2. Assuming she does have confirmed endometriosis, I would begin pituitary down-regulation with a GnRH agonist and then continue that for 3 to 6 months, depending on your examination, ultrasound, and symptomatic response. 3. Your options then, depending on symptoms and anatomic findings, would be to switch to oral contraceptives, continue GnRHa with add-back therapy, or perform a laparoscopy (and laparotomy if indicated) while still down-regulated.
-- George M. Grunert, M.D. Director, Assisted Reproduction Program Obstetrical and Gynecological Associates 7550 Fannin Houston, Texas 77054 713-512-7851 fax 713-512-7853 grunert@icsi.net
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