Abstract
BackgroundDeeply infiltrating endometriosis has an estimated prevalence of 1% in women of reproductive age. Ninety percent 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.ResultsOne hundred fifty-two women with deeply infiltrating endometriosis were discussed at our endometriosis multidisciplinary meeting between January 2010 and December 2016. Seventy-five percent 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.ConclusionsMedical 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.
Highlights
Infiltrating endometriosis has an estimated prevalence of 1% in women of reproductive age
Women included in the analysis were diverse in regards to their symptoms, severity of disease and previous medical and surgical managements. 70.4% (107/152) of women had tried some form of hormonal therapy prior to referral to the endometriosis service, with 21.7% (33/152) trying more than one preparation
29.6% (45/152) women had not tried any form of medical management in the past, even for the purposes of contraception. 27.6% (42/152) of women had not had any form of surgical intervention for endometriosis or pelvic pain in the past. 50.7% of women (77/152) had one previous surgical procedure and 5.3% (8/152) of women had undergone at least two surgical procedures
Summary
Infiltrating endometriosis has an estimated prevalence of 1% in women of reproductive age. Infiltrating endometriosis (DIE) is defined as endometriotic tissue found more than 5 mm below the peritoneal surface. It has an estimated prevalence of 1% in women of reproductive. To be able to manage symptomatic disease with relatively simple, reversible medical treatments is an attractive solution. This approach has the advantage of avoiding patient morbidity associated with complex surgery, including complications such as haemorrhage, infection and bladder, bowel or ureteric injury. The inevitable neurological damage sustained during radical dissection, causing constipation, voiding difficulties and sexual dysfunction may be circumvented by using medical therapies first-line
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