Evaluation and management of endometriosis

Abstract

The initial diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The pelvic examination should include a speculum examination and vaginal palpation. Mobility, fixation and/or tenderness of the uterus and site-specific tenderness in the pelvis should be evaluated. Transvaginal ultrasound and pelvic magnetic resonance imaging are recommended to evaluate the extent of the endometriosis and to determine whether any urinary tract or bowel procedures might also be required during surgical resection. Quality of life should be assessed by using the Endometriosis Health Profile-30, its short version EHP-5 or the generic quality of life questionnaire SF-36. Management of endometriosis is recommended when it has a functional impact (pain, infertility) or causes organ dysfunction. Many gynecological societies have published different guidelines for the evaluation and management of endometriosis. However, the complexity of this disease together with the different available treatments lead to significant discrepancies between the recommendations. Postmenopausal endometriosis should be considered when a patient has a history of symptoms before menopause including dysmenorrhea, dyspareunia, dyschezia, infertility and chronic pelvic pain. Malignant transformation of endometriosis is estimated to occur in about 0.7–1.6% of women affected by endometriosis. Endometriosis is associated with an increased risk of ovarian cancer, specifically clear cell, endometrioid and low-grade serous types.

摘要

子宫内膜异位症的初步诊断研究是体格检查和盆腔超声检查。骨盆检查应包括窥器检查和阴道触诊。应评估子宫的活动性、固定性和/或压痛以及骨盆的特定部位压痛。建议通过阴道超声和盆腔磁共振成像来评估子宫内膜异位症的程度, 并确定手术切除过程中是否也需要进行任何尿路或肠道手术。应使用子宫内膜异位症健康概况-30、简称EHP-5或通用生活质量问卷SF36来评估生活质量。当子宫内膜异位症有功能影响（疼痛、不孕）或导致器官功能障碍时, 建议对其进行治疗。许多妇科学会发布了不同的子宫内膜异位症评估和管理指南。然而, 这种疾病的复杂性以及不同的可用治疗方法导致了建议之间的显著差异。当患者在绝经前有痛经、性交困难、排便困难、不孕和慢性骨盆疼痛等症状时, 应考虑绝经后子宫内膜异位症。据估计, 子宫内膜异位症的恶性转化发生在约0.7-1.6%的子宫内膜异位患者中。子宫内膜异位症与卵巢癌风险增加有关, 特别是透明细胞癌、子宫内膜样癌和低度浆液性癌。

Keywords:

• Endometriosis
• pelvic pain
• infertility
• postmenopausal endometriosis
• endometriosis recurrence
• malignant transformation

Acknowledgements

The author alone is responsible for the content and writing of the article.

Potential conflict of interest

The author reports no conflict of interest.

Source of funding

None.