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Endometriosis: Diagnosis and Treatment
Diagnosis
- A medical history and a physical examination are the first steps.
Tender nodules and masses may be felt or seen on the vagina or
cervix during pelvic examination.
- Many gynecologists believe that
definitive diagnosis can be made only by surgical visualization
and/or biopsy. However, others believe that endometriosis is better
diagnosed by history, physical examination, and response to therapy.
- Blood
tests may suggest the diagnosis and can be used to follow the patient’s
response to medical treatment.
- Colonoscopy or cystoscopy (a test
that visualizes the inside of the bladder) may reveal endometriosis
in the colon and bladder.
- Ultrasound may be used to detect large
areas of endometriosis that may require surgical removal.
Treatment
The treatment strategy depends on the severity of disease,
proximity to menopause, and whether the patient hopes to become pregnant.
After menopause, symptoms will likely improve dramatically without
specific treatment, even in severe disease.
- Analgesics (e.g., acetaminophen (Tylenol) and ibuprofen) and
oral contraceptive pills are used for pain relief. Oral contraceptives
may also reduce the risk of ovarian cancer.
- Several medical therapies,
including gonadotropin–releasing hormone analogs (e.g., nafarelin,
leuprolide and goserelin), danazol, or progestins, may be helpful.
Treatment usually lasts at least six months.
- Medical therapy affords
long–term relief in about 50 percent of patients. Surgery is often
used for severe disease, although it has not been proven superior
to medical therapy. Laser therapy may treat the pain, decrease
the rate of recurrence, and restore fertility. If there is no desire
for future pregnancy, definitive treatment is a hysterectomy. However,
most patients can be managed effectively without such extreme measures.
- Women who exercise have a much lower risk for endometriosis,
and those who engage in frequent strenuous exercise have at least
75 percent lower risk for endometriosis, compared with those who
do not engage in high–intensity activity.
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