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Email this article Combined Surgical and Hormonal Approach as a Treatment Option for Deep Endometriosis
Abstract
Background: Deep endometriosis represents a chronic, progressive disease, frequently characterized by pelvic pain and infertility.
Although laparoscopic surgery is the mainstay of treatment for severe endometriosis-associated pain or failed medical therapy, post-surgical management of the disease still remains a subject of discussion. As for infertility treatment, the effectiveness of surgical intervention remains controversial due to the lack of robust trials.
Few existing studies suggest that the use of selective progestin–dienogest may have a positive effect on improving endometriosis-associated pain, fertility rate and in-vitro outcomes A possible improvement in the prognosis may be attributed to the positive effect of dienogest on the eutopic endometrium, which is structurally altered in endometriosis. Therefore it has become reasonable to include hormonal therapy for the effective management of endometriosis aftersurgical intervention.
Aim of the study: We aimed to observe the available literature data to weigh prospects of combined surgical and medical therapy for more effective management of endometriosis. To bring more insights into better understanding the challenges associated with endometriosis treatment, epidemiology, classification systems, pathogenesis along with current treatment options were reviewed.
Materials and methods: For this purpose following electronic databases were searched: PubMed, Medline, Scopus, Cochrane Library, Web of Science, WES, Science Direct, NCBI, National Library of Medicine, Springer.
Results: Overall, 120 articles, expert recommendations and practice committee options were reviewed, 59 of them displayed certain degree of statistical significance. They were analyzed and discussed in our article.
Conclusion: After literature review, it has become more obvious that existing research data are mostly heterogeneous and inconclusive; therefore, the majority of study findings can't be generalized. Research data is limited to accurately analyze and determine the timing and duration of optimal hormonal therapy after surgery for deep endometriosis. Further studies are needed to address the challenges of effective management of endometriosis.
Keywords: Deep endometriosis; infertility; pelvic pain; dienogest.
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