Sites of Endometriosis



Implants of endometriosis on the surface of the ovary



A dark endometrial implant in the vaginal wall.



Ovarian endometrioma

Diagnosis (3) - Laparoscopy

 

Generally used to confirm diagnosis – hallmarks of the disease are adhesions peritoneal or retroperitoneal implants, and endometriomas Lesions may be seen:



typical: pigmented, dark, powder-burn nodules



atypical: non-pigmented, clear, white, red flame-like, yellow-brown nodules

Diagnosis (3a) Laparoscopy Patient A Characteristic powder burn lesion viewed on the surface of the uterus using laparoscopy

Diagnosis (3b) Laparoscopy Patient B Ovary and fallopian tube identifiable in this laparoscopy image

Diagnosis (3c) Laparoscopy Patient C Flame-like lesion viewed on the surface of the uterus using laparoscopy



Implants on the surface of the peritoneum

 

Ovarian endometrioma Lesions in the pouch of Douglas

Hormonal Therapy GnRH agonists Decapeptyl ®



Mode of action



Suppression of the hypothalamic-pituitary gonad axis



‘Starving’ of the endometrial tissue by blocking oestrogen and progesterone

Hormonal Therapy GnRH agonists - Decapeptyl ®



Efficacy



Relief of pain in approx. 90 % o f all patients

A comparative trial (triptorelin vs placebo) from Bergquist

et al.,

1998 confirmed that this is due to the action of Decapeptyl ® Depot 

Reduction of the size of endometriomas by 50 % within 3 months before after

Add-back therapy: Rationale GnRHa Decrease of endometriosis symptoms AddBack Increase of menopausal symptoms