Endometriosis- Management

Endometriosis- Management

It is the presence of endometrial glands and stroma in locations other than the uterine endometrium and musculature. The common locations of endometriosis include the pelvis, small intestines, bowels, appendix, anterior abdominal wall, and incision scars.

Clinical presentation

• Chronic pelvic pain, lower back pain, and rectal pain

• Dysmenorrhea

• Dyspareunia

• Dysfunctional uterine bleeding

• Infertility

Management at dispensary and health center

• Ibuprofen (PO) 200–600 mg 8 hourly (maximum 2.4 g/day)

  
  

  OR

• Acetylsalicylic acid (PO) 300–600 mg 4 hourly

  
  

  OR

• Diclofenac (PO) 50–100 mg 8–12 hourly

  
  

  OR

• Mefenamic acid (PO) 500 mg 8 hourly

  
  

  OR

• Hyoscine butyl bromide (PO) 20 mg 8 hourly for 5 days

Referral: Refer the patient with endometriosis to hospital for further investigations and management.

Management of endometriosis at hospital

Investigations

• Abdominal pelvic/transvaginal ultrasound

• CT scan

• MRI

• Laparoscopy

Pharmacological treatment of endometriosis

• Combined oral contraceptive pills (PO) 1 tablet 24 hourly for 3 months

  
  

  OR

• Medroxyprogesterone acetate (IM) 300 mg monthly for 6 months

  
  

  OR

• Danazol (PO) 200–400 mg 12 hourly depending on the severity; continue treatment to maintain amenorrhea

  
  

  OR

• Goserelin (IM) 3.6 mg monthly for 4–6 months