Medical management of deeply infiltrating endometriosis - 7 year experience in a tertiary endometriosis centre in London
File(s)
Published version
Author(s)
Wild, Marianne
Miskry, Tariq
Al-Kufaishi, Asmaa
Rose, Gillian
Crofton, Mary
Type
Journal Article
Abstract
Background: Deeply infiltrating endometriosis has an estimated prevalence of 1% in women of reproductive age. 90% have rectovaginal lesions but disease may also include the bowel, bladder and ureters. Current practice often favours minimally invasive surgical excision, however, there is increasing evidence that medical management can be as effective as long as obstructive uropathy and bowel stenosis are excluded. Our objective was to establish the proportion of women with deeply infiltrating endometriosis successfully managed with hormonal therapies within our tertiary endometriosis centre in West London. Secondary analysis was performed on anonymised data from the Trust’s endometriosis database. Results: 152 women with deeply infiltrating endometriosis were discussed at our endometriosis multidisciplinary meeting between January 2010 and December 2016. 75% of women underwent a trial of medical management. Of these, 44.7% did not require any surgical intervention during the study period, and 7.9% were symptomatically content but required interventions to optimise their fertility prospects. Another 7.0% were successfully medically managed for at least 12 months, but ultimately required surgery as their symptoms deteriorated. 26.5% took combined oral contraceptives, 14.7% oral progestogens, 1.5% progestogen implant, 13.2% levonorgestrel intrauterine device, 22.1% gonadotrophin releasing hormone analogues and 22.1% had analogues for 3–6 months then stepped down to another hormonal contraceptive. All women who underwent serial imaging demonstrated improvement or stable disease on MRI or ultrasound. Conclusions: Medical treatments are generally safe, well tolerated and inexpensive. More than half (52.6%) of women were successfully managed with medical therapy to control their symptoms. This study supports the growing evidence supporting hormonal therapies in the management of deeply infiltrating endometriosis. The findings may be used to counsel women on the likely success rate of medical management.
Date Issued
2019-12-03
Date Acceptance
2019-10-31
Citation
Gynecological Surgery: endoscopy, imaging, and allied techniques, 2019, 16
ISSN
1613-2076
Publisher
SpringerOpen
Journal / Book Title
Gynecological Surgery: endoscopy, imaging, and allied techniques
Volume
16
Copyright Statement
© The Author(s) 2021. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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Subjects
1114 Paediatrics and Reproductive Medicine
Obstetrics & Reproductive Medicine
Publication Status
Published
Article Number
ARTN 12