Abstract
Study Objective
To evaluate the effect of combined surgical-medical treatment on endometriosis progression
in adolescents as measured by disease stage.
Design
Retrospective chart review.
Setting
Two academic medical centers.
Participants
Sequential cases of young women identified on chart review with chronic pelvic pain
unresponsive to dysmenorrheal treatment who underwent initial laparoscopy for diagnosis
and surgical destruction of endometriosis. All patients were then treated with standard
continuous medical therapy. Patients with exacerbation of pain on anti-endometriosis
medical therapy who elected a subsequent laparoscopic procedure were eligible for
this study.
Intervention
Retrospective chart review
Main Outcome Measures
Endometriosis stage and adhesions at subsequent laparoscopy as compared to the initial
surgical procedure.
Results
90 patients met inclusion criteria. Eligible patients were 12 to 24 years of age at
the time of the initial laparoscopy. The median endometriosis stage at first and second
laparoscopy was I. No stage change was observed in 70% of patients, 19% improved by
one stage, 1% improved by two stages, and 10% worsened by one stage. Regardless of
initial stage, a trend toward disease progression was not observed. There was a significant
likelihood for stage improvement at second laparoscopy, with those initially diagnosed
as stage II or III most likely to exhibit improvement.
Conclusions
Based on the concept that endometriosis can be progressive, these data suggest that
combined surgical-medical management retards disease progression in adolescents and
young adults.
Key Words
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References
- Adolescent endometriosis: diagnosis and treatment approaches.J Pediatr Adolesc Gynecol. 2003; 16: S3
- Redefining endometriosis: is deep endometriosis a progressive disease?.Hum Reprod. 2000; 15: 1
- Clinical relevance of the baboon as a model for the study of endometriosis.Fertil Steril. 1997; 68: 613
- Endometriosis–a disease because it is characterized by bleeding.Am J Obstet Gynecol. 1997; 176: 263
- Epidemiology of endometriosis among parous women.Obstet Gynecol. 1995; 85: 983
- Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors.Am J Epidemiol. 2004; 160: 784
- Prevalence of endometriosis in adolescent women with chronic pelvic pain not responding to conventional therapy.J Pediatr Adolesc Gynecol. 1997; 10: 199
- The impact of treatment on the natural history of endometriosis.Hum Reprod. 1990; 5: 965
- Placebo controlled comparison of danazol and high dose medroxyprogesterone acetate in the treatment of endometriosis.Gynecol Endocrinol. 1987; 1: 13
- Successful treatment of asymptomatic endometriosis: does it benefit infertile women?.BMJ. 1987; 294: 1117
- Number 310, April 2005. Endometriosis in adolescents.Obstet Gynecol. 2005; 105: 921
- Guidelines for the R-ASRM 1996 Endometriosis Classification System.Fertil Steril. 1996; 67: 817
- Identification of clear vesicular lesions of atypical endometriosis: a new technique.Fertil Steril. 1997; 68: 739
- Clinical characteristics of adolescent endometriosis.J Adolesc Health. 1993; 14: 362
- Changing trends in the diagnosis of endometriosis: a comparative study of women with pelvic endometriosis presenting with chronic pelvic pain or infertility.Fertil Steril. 1997; 67: 238
- Adolescent endometriosis.J Adolesc Health Care. 1980; 1: 37
- Endometriosis in an adolescent population: the Emory experience.J Pediatr Adolesc Gynecol. 1996; 9: 125
- Stage and location of pelvic endometriosis and pain.Fertil Steril. 1990; 53: 155
- Endometriosis and pelvic pain: relation to disease stage and localization.Fertil Steril. 1996; 65: 299
- ESHRE guideline for the diagnosis and treatment of endometriosis.Hum Reprod. 2005; 20: 2698
- American College of Obstetricians and Gynecologists. Medical management of endometriosis.ACOG Practice Bulletin No 11. Author, Washington, DC1999
- Treatment of endometriosis.Lancet. 1992; 340: 1267
- Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis.Fertil Steril. 1994; 62: 696
- Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis.Fertil Steril. 1997; 68: 1070
- Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis of reoperation and persistent or recurrent disease.Fertil Steril. 1991; 56: 628
- Recurrence of endometriomas after laparoscopic removal: sonographic and clinical follow-up and indication for second surgery.J Minim Invasive Gynecol. 2006; 13: 281
- Recurrence of ovarian endometrioma after laparoscopic excision.Am J Obstet Gynecol. 1999; 180: 519
- Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III–IV. A randomized comparative trial.Fertil Steril. 2007; 88: 1541
- Prospective randomized study comparing the GnRH-agonist leuprorelin acetate and the gestagen lynestrenol in the treatment of severe endometriosis.Gynecol Endocrinol. 2001; 15: 202
- Use of nafarelin versus placebo after reductive laparoscopic surgery for endometriosis.Fertil Steril. 1997; 68: 860
- Evaluation and management of women with endometriosis.Obstet Gynecol. 2003; 102: 397
- Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multicenter, randomized study.Fertil Steril. 2002; 77: 684
- Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study.Fertil Steril. 2003; 80: 305
- The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions Research Study.BJOG. 2000; 107: 855
- Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24 046 patients.Hum Reprod. 2004; 19: 1877
- Adhesion-related small-bowel obstruction after gynecologic operations.Am J Obstet Gynecol. 1999; 180: 313
- Adhesion-related bowel obstruction after hysterectomy for benign conditions.Obstet Gynecol. 2006; 108: 1162
- The revised American Fertility Society classification of endometriosis: reproducibility of scoring. ZOLADEX Endometriosis Study Group.Fertil Steril. 1995 May; 63: 1108
- Reproducibility of the revised American Fertility Society classification of endometriosis using laparoscopy or laparotomy.Int J Gynaecol Obstet. 1998; 60: 265
- The reproducibility of the revised American Fertility Society classification of endometriosis.Fertil Steril. 1993; 59: 1015
- Interobserver variability in the diagnosis of minimal and mild endometriosis.Eur J Obstet Gynecol Reprod Biol. 2005; 122: 213
Article info
Footnotes
This study was presented in part at the 2008 Annual Clinical Meeting of the North American Society of Pediatric and Adolescent Gynecology, Newport Beach, CA
Identification
Copyright
© 2009 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
