http://austinpublishinggroup.com/obstetrics-gynecology/
Endometriosis is defined as the presence of endometrial glands
and stroma outside the uterine cavity. The prevalence rate of endometriosis is
approximately 5-10% of all women of reproductive age, it reduces the patient’s
quality of life through the occurrence of pain, including dysmenorrhea, dyspareunia,
and lower back pain.
It is known that the primary treatment of endometriosis is
surgery. The European Society of Human Reproduction and Embryology (ESHRE)
guidelines state that surgical treatment is warranted for an ovarian
endometrioma of larger than 3 cm, and that laparoscopic stripping of the cyst
wall is considered the gold standard for treatment. Because the surgical
excision of lesions has shown to improve the level of pain and enhance
fertility, ovarian cystectomy is preferable to oophorectomy, and most women who
undergo endometriosis are of childbearing age. However, a pooled analysis of 23
studies estimated the recurrence rates as 40% to 50% 5 years after the primary
surgery. Medical treatment for the relief of symptoms and the prevention of
recurrence after surgery include Gonadotropin-Releasing Hormone (GnRH) analogs,
progestin, danazol, and estrogen/progestin combinations. However, these
treatments have adverse.
effects including impaired hepatic function associated with
danazol, as well as a decrease in bone mineral density, which may be caused by
GnRH analogs. Thus, their long-term use is limited. Dienogest (Visanne, Bayer
HealthCare, Berlin, Germany) is a selective progestin that has been approved
for treating endometriosis at a low oral dose of 2 mg/day. Dienogest has many
beneficial pharmacological uses, such as a potential progestogenic effect,
moderate suppression of estrogen, and low concern for increased androgen and
corticoid levels. Progestogenic effects lead to an effective reduction in
endometrial lesions, and no significant androgenic, mineralocorticoid, or
glucocorticoid activity.
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