Advertisement

Human Reproduction: From State of the Art to Future Developments “Endometriosis Therapeutic Approaches”

  • Liselotte MettlerEmail author
  • Ibrahim Alkatout
Chapter
Part of the Reproductive Medicine for Clinicians book series (REMECL, volume 1)

Abstract

In this evaluation, the first part evaluates three different treatment strategies (hormonal medication, surgical treatment, or combined treatment) and discusses the influence of endometriosis on pregnancy outcome. Four hundred and fifty patients with genital endometriosis, aged 18–44 years, were randomly distributed to three treatment groups at the first laparoscopy. They were reevaluated at a second-look laparoscopy (D 426/10), 1–2 months after the 3-month hormonal therapy for groups 1 and 3 and 5–6 months later for group 2 (surgical treatment alone). Outcome data focused on the recurrence and pregnancy rate.

The three treatment options—independent of the initial endoscopic endometriosis classification (EEC) stage including deep infiltrating endometriosis (DIE)—achieved an overall cure rate of 50% or higher. The highest cure rate of 60% was achieved by the combined treatment, 55% by the exclusive hormonal therapy, and 50% by the exclusive surgical treatment. An overall pregnancy rate between 55 and 65% was achieved with no significant difference in relation to the therapeutical option.

Further we consider in the second part the relation of pregnancy and endometriosis with the following conclusions: (1) increased risk for premature deliveries and pregnancy complications, (2) more frequent preeclampsia and antepartum hemorrhage, (3) increased rate of Cesarean sections, (4) severe pain in pregnancy continues in quite a few patients, and (5) obstetricians should be aware of obstetric emergencies, such as direct bleeding from lesions, bleeding from uterine arteries or veins, interruption of ureter, and severe peritoneal decidualized endometriosis.

Keywords

Endometriosis Medical and surgical management Pregnancies 

References

  1. 1.
    Johnson NP, Hummelshoj L. Consensus on current management of endometriosis. Hum Reprod. 2013;28(6):1552–68.CrossRefGoogle Scholar
  2. 2.
    Hughes E, et al. Ovulation suppression for endometriosis. Cochrane Database Syst Rev. 2007;(3):CD000155.Google Scholar
  3. 3.
    Strowitzki T, et al. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod. 25(3):633–41.CrossRefGoogle Scholar
  4. 4.
    Zupi E, et al. Add-back therapy in the treatment of endometriosis-associated pain. Fertil Steril. 2004;82(5):1303–8.CrossRefGoogle Scholar
  5. 5.
    Wong CL, et al. Oral contraceptive pill as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev. 2009;(2):CD002120.Google Scholar
  6. 6.
    Davis L, et al. Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2007;(3):CD001019.Google Scholar
  7. 7.
    Mousa NA, Bedaiwy MA, Casper RF. Aromatase inhibitors in the treatment of severe endometriosis. Obstet Gynecol. 2007;109(6):1421–3.CrossRefGoogle Scholar
  8. 8.
    Ferrero S, et al. Letrozole combined with norethisterone acetate compared with norethisterone acetate alone in the treatment of pain symptoms caused by endometriosis. Hum Reprod. 2009;24(12):3033–41.CrossRefGoogle Scholar
  9. 9.
    Mettler L, et al. Challenges of endometriosis. Eur Obstet Gynecol. 2011;6(2):83–90.Google Scholar
  10. 10.
    Olive DL, Schwartz LB. Endometriosis. N Engl J Med. 1993;328(24):1759–69.CrossRefGoogle Scholar
  11. 11.
    Kennedy S, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698–704.CrossRefGoogle Scholar
  12. 12.
    Stegmann BJ, et al. Using location, color, size, and depth to characterize and identify endometriosis lesions in a cohort of 133 women. Fertil Steril. 2008;89(6):1632–6.CrossRefGoogle Scholar
  13. 13.
    Wykes CB, Clark TJ, Khan KS. Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic quantitative review. BJOG. 2004;111(11):1204–12.CrossRefGoogle Scholar
  14. 14.
    Christensen B, Freie HM, Schindler AE. Endometriosis—diagnosis and therapy. Results of a current survey of 6,700 gynecologists. Geburtshilfe Frauenheilkd. 1995;55(12):674–9.CrossRefGoogle Scholar
  15. 15.
    Medicine PCoASfR. Treatment of pelvic pain associated with endometriosis. Fertil Steril. 2008;90(5 Suppl):S260–9.Google Scholar
  16. 16.
    Buchweitz O, et al. The diagnostic dilemma of minimal and mild endometriosis under routine conditions. J Am Assoc Gynecol Laparosc. 2003;10(1):85–9.CrossRefGoogle Scholar
  17. 17.
    Mettler L, Schollmeyer T, Alkatout I. Adhesions during and after surgical procedures, their prevention and impact on women's health. Women's Health (Lond Engl). 2012;8(5):495–8.CrossRefGoogle Scholar
  18. 18.
    Alkatout I, et al. Endometriose: Medikamentöse und operative Therapieoptionen. gynäkologie + geburtshilfe. 2013;18(1):38–45.CrossRefGoogle Scholar
  19. 19.
    Abbott J, et al. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril. 2004;82(4):878–84.CrossRefGoogle Scholar
  20. 20.
    Healey M, Ang WC, Cheng C. Surgical treatment of endometriosis: a prospective randomized double-blinded trial comparing excision and ablation. Fertil Steril. 2010;94(7):2536–40.CrossRefGoogle Scholar
  21. 21.
    Jacobson TZ, et al. Laparoscopic surgery for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2001;(4):CD001300.Google Scholar
  22. 22.
    Crosignani PG, et al. Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis. Fertil Steril. 1996;66(5):706–11.CrossRefGoogle Scholar
  23. 23.
    Taylor E, Williams C. Surgical treatment of endometriosis: location and patterns of disease at reoperation. Fertil Steril. 2010;93(1):57–61.CrossRefGoogle Scholar
  24. 24.
    Yeung PP Jr, Shwayder J, Pasic RP. Laparoscopic management of endometriosis: comprehensive review of best evidence. J Minim Invasive Gynecol. 2009;16(3):269–81.CrossRefGoogle Scholar
  25. 25.
    Engemise S, Gordon C, Konje JC. Endometriosis. BMJ. 2010;340:c2168.CrossRefGoogle Scholar
  26. 26.
    Alkatout I, et al. Combined surgical and hormone therapy for endometriosis is the most effective treatment: prospective, randomized, controlled trial. J Minim Invasive Gynecol. 2013;20(4):473–81.CrossRefGoogle Scholar
  27. 27.
    Mettler L. Diagnostik und Therapie der Endometriose. Eur Secur. 1984;5:234–40.Google Scholar
  28. 28.
    Mettler L, Semm K. Three step medical and surgical treatment of endometriosis. Ir J Med Sci. 1983;152(Suppl 2):26–8.CrossRefGoogle Scholar
  29. 29.
    Stephansson O, et al. Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome. Hum Reprod. 2009;24(9):2341–7.CrossRefGoogle Scholar
  30. 30.
    Brosens I, et al. The enigmatic uterine junctional zone: the missing link between reproductive disorders and major obstetrical disorders? Hum Reprod. 2010;25(3):569–74.CrossRefGoogle Scholar
  31. 31.
    Hadfield RM, et al. Is there an association between endometriosis and the risk of pre-eclampsia? A population based study. Hum Reprod. 2009;24(9):2348–52.CrossRefGoogle Scholar
  32. 32.
    Wood R. Myths and misconceptions in endometriosis.Google Scholar
  33. 33.
    Mettler L, et al. Identification of the M-CSF receptor in endometriosis by immunohistochemistry and RT-PCR. Am J Reprod Immunol. 2004;52(5):298–305.CrossRefGoogle Scholar
  34. 34.
    Mettler L, et al. Comparison of c-DNA microarray analysis of gene expression between eutopic endometrium and ectopic endometrium (endometriosis). J Assist Reprod Genet. 2007;24(6):249–58.CrossRefGoogle Scholar
  35. 35.
    Sampson JA. Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into peritoneal cavity. Am J Obstet Gynecol. 1927;14:422–69.CrossRefGoogle Scholar
  36. 36.
    Ebert AD, editor. Endometriose. Berlin: Walther de Gruyter Verlag; 2003.Google Scholar
  37. 37.
    Schweppe KW, et al., editors. Endometriose: Entstehung, Diagnostik, Behandlungsmöglichkeiten und Probleme in Klinik und Praxis. Heidelberg: Seminar in Gynäkologische Endokrinologie; 2012. p. 516–34.Google Scholar
  38. 38.
    Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril. 2010;94(5):1609–15.CrossRefGoogle Scholar
  39. 39.
    Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev. 2004;(3):CD003678.Google Scholar
  40. 40.
    Seracchioli R, et al. Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis. Hum Reprod. 2009;24(11):2729–35.CrossRefGoogle Scholar
  41. 41.
    Schweppe KW. Therapie der Endometriose unter Berücksichtigung der Aktivitätsgrade. Gynakologe. 2002;35:255–61.CrossRefGoogle Scholar
  42. 42.
    Schindler AE, et al. Treatment of endometriosis with the GnRH agonist buserelin (Suprecur): a multicenter study. Geburtshilfe Frauenheilkd. 1994;54(10):569–73.CrossRefGoogle Scholar
  43. 43.
    Regidor PA, et al. Treatment of endometriosis with the GnRH analog triptorelin with special reference to the effect on bone density. Zentralbl Gynakol. 1993;115(11):473–7.PubMedGoogle Scholar
  44. 44.
    Raitz von Frentz M, Schweppe KW. Ovarian suppression by the GnRH analog buserelin in the treatment of endometriosis. Clinical, biochemical and pelviscopic studies. Geburtshilfe Frauenheilkd. 1990;50(8):634–9.CrossRefGoogle Scholar
  45. 45.
    Romer T, Schwesinger G. Wie durchbricht man den Teufelskreis der aktiven Endometriose? Neue Aspekte der Therapieentscheidung bei aktiver Endometriose. Zentralbl Gynakol. 1999;121(7):336–40.PubMedGoogle Scholar
  46. 46.
    Regidor PA, et al. Prospective randomized study comparing the GnRH-agonist leuprorelin acetate and the gestagen lynestrenol in the treatment of severe endometriosis. Gynecol Endocrinol. 2001;15(3):202–9.CrossRefGoogle Scholar
  47. 47.
    Guzick DS, et al. Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Fertil Steril. 2011;95(5):1568–73.CrossRefGoogle Scholar
  48. 48.
    Sutton CJ, et al. 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(4):696–700.CrossRefGoogle Scholar
  49. 49.
    Cahill DJ. What is the optimal medical management of infertility and minor endometriosis? Analysis and future prospects. Hum Reprod. 2002;17(5):1135–40.CrossRefGoogle Scholar
  50. 50.
    Marcoux S, Maheux R, Berube S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med. 1997;337(4):217–22.CrossRefGoogle Scholar
  51. 51.
    Barcena de Arellano ML, et al. Overexpression of nerve growth factor in peritoneal fluid from women with endometriosis may promote neurite outgrowth in endometriotic lesions. Fertil Steril. 2011;95(3):1123–6.CrossRefGoogle Scholar
  52. 52.
    Keichel S, et al. Lymphangiogenesis in deep infiltrating endometriosis. Hum Reprod. 2011;26(10):2713–20.CrossRefGoogle Scholar
  53. 53.
    Somigliana E, Vigano P, Vignali M. Endometriosis and unexplained recurrent spontaneous abortion: pathological states resulting from aberrant modulation of natural killer cell function? Hum Reprod Update. 1999;5(1):40–51.CrossRefGoogle Scholar
  54. 54.
    Chiodo I, et al. Urohemoperitoneum during pregnancy with consequent fetal death in a patient with deep endometriosis. J Minim Invasive Gynecol. 2008;15(2):202–4.CrossRefGoogle Scholar
  55. 55.
    Wada S, et al. Uterine vein rupture at delivery as a delayed consequence of laparoscopic surgery for endometriosis: a case report. J Minim Invasive Gynecol. 2009;16(4):510–2.CrossRefGoogle Scholar
  56. 56.
    Falcao JJ, SJ WE. Endometriosis in obstetric emergency. Free Communications and Posters, P1–108, in 11 th World Congress of Endometriosis, Montpellier, France, 4–7 September 2011.Google Scholar
  57. 57.
    Mabrouk M, et al. Spontaneous postpartum hemoperitoneum in primipara with decidualized pelvic endometriosis. Free Communication and Posters, P1–112, in 11 th World Congress on Endometriosis, Montpellier, France, 4–7 September 2011.Google Scholar
  58. 58.
    Mettler L, et al. Accuracy of laparoscopic diagnosis of endometriosis. JSLS. 2003;7(1):15–8.PubMedPubMedCentralGoogle Scholar
  59. 59.
    da Silva-Filho AL, Ferreira MCF, Lamaita RM, Rocha ALL, Cândido EB, Carneiro MM. Endometriosis and ovarian cancer: from molecular evidences to clinical implications. Journal of Endometr. 2016;8(3):81–6.  https://doi.org/10.5301/je.5000248.CrossRefGoogle Scholar
  60. 60.
    Bluett R, Fonseca-Kelly Z, Burke C. Efficacy of surgical intervention for the treatment of pain and improvement of quality of life in patients with endometriosis. J Endometr. 2016;8(3):101–5.  https://doi.org/10.5301/je.5000246.CrossRefGoogle Scholar

Copyright information

© IAHR (International Academy of Human Reproduction) 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyUniversity Clinics of Schleswig-HolsteinKielGermany

Personalised recommendations