I-22: Quality of Life in Patients with Endometriosis

Endometriosis is defined as presence of endometrial tissue outside of the uterus. It is a common disorder of women in reproductive age. It is estimated to occur in ten percent iof women in this age and even more in patients with infertility and pelvic pain. Endometriosis varies in appearance from a few minimal lesions to massive ovarian endometriotic cysts that distort the tubo-ovarian anatomy and extensive adhesions and involvement of bowel, ureter, and bladder. Extra pelvic lesions are seen but with much less occurrence. This disease can decrease ovarian reserves of ovums and chance of premature menopause is increased especially with bilateral ovarian involvement. This complication is seen after surgical treatment of endometrioma and should be discussed with patients' before operation and a full consent should be taken. There are many diagnostic modalities for endometriosis such as combination of some markers and imaging techniques such as TVS, TRS, and MRI. Imaging techniques have a high sensitivity and specificity for ovarian endometriosis but not for peritoneal or deep infiltrative endometriosis (DIE). The gold standard for diagnosis of endometriosis is laparoscopy and histopathologic evaluation of lesions. Many classification systems were perposed but most of them are subjective and correlates poorly with pain symptoms but may be of value in infertility prognosis and management. Medical treatments are not indicated for patients with endometriosis and infertility but should be considered for those with pain and as a adjuvant after surgical treatment. In those patients with infertility laparoscopic treatment of endometriosis or controlled ovarian hyperstimulation with intrauterine insemination (COH-IUI) and assisted reproductive technology (ART) are the best modalities. ART is the method of choice for those with severe distortion of tubo-ovarian anatomy. Because hormonal suppressive treatment does not cure endometriosis recurrence or persistence of endometriosis can be expected in nearly all patients after the cessation of medical treatment, and this is positively correlated with the severity of endometriosis. The main goal of laparoscopic treatment of patients with pain is to resect all endometriotic lesions as much as possible. It is the most difficult pelvic operation and should performed by an expert laparoscopist. When endometriosis causes mechanical distortion of the pelvis surgery should be performed to achieve reconstruction of normal pelvic anatomy. Surgical management of minimal and mild endometriosis appears to offer a small, but significant, benefit with regard to fertility outcome. Sometimes patients should be operated by a team of expert gynecologic laparoscopist and urologist or colorectal surgeon especially in thse with bowel and ureter involvement. Even with advance surgery and medical treatment there is a real chance of recurrence of the disease and this subject should be discussed with the patient. She should be advised about this chronic disease that potentially affect her quality of life and should be informed about the potential complications of the disease and medical or surgical treatments. Coping with endometriosis as a chronic disease is an important component of management. Psychiatric consult may be helpful in those patients with intractable pain and those with depression following to the disease.