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Advances in the medical management of endometriosis
Author(s) -
Vincent K,
Kennedy S,
Moore J
Publication year - 2008
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2008.01863.x
Subject(s) - obstetrics and gynaecology , medicine , general hospital , library science , family medicine , pregnancy , computer science , genetics , biology
Sir, Dr Panay has presented a very clear and thorough overview of recent advances in the medical management of endometriosis.1 As he points out, we are often unable to achieve one of the aims of medical therapy, which is to relieve pain. In some instances, this must occur because the endometriosis found at laparoscopy is not actually the cause of the pain; therefore, neither medical nor surgical treatment of the endometriosis present will relieve symptoms. In other cases, secondary pain generators may result from the presence of endometriosis, which do not resolve when it is treated. Recent work2 has demonstrated that endometriotic implants develop a sensory and sympathetic nerve supply. It is possible that these nerves become damaged or sensitised by inflammation generated by the implants or surgical trauma leading to an additional ‘neuropathic’ component to the pain. Furthermore, viscero-viscero-somatic convergence3 in the spinal cord can lead to symptoms suggestive of interstitial cystitis and irritable bowel syndrome and to musculoskeletal symptoms, including trigger points,4 in both the anterior abdominal wall and the pelvic floor. Although bowel and bladder symptoms often resolve with treatment of the underlying cause, physiotherapy and/or local injection may be necessary to improve those generated by the muscles. A trial of a drug such as amitriptyline or gabapentin may also be justified, especially if the woman describes her pain with words such as ‘sharp, stabbing or burning’. Thus, while we welcome these new advances in treatments for endometriosis and the continuing research, we would like to highlight the importance of secondary generators of pain. Careful history taking and examination may identify those symptoms that, although not classically attributable to endometriosis, may well be related to its pathophysiology and that, if ignored, may reduce the likelihood of successful treatment. When these symptoms are themselves amenable to treatment, a welcome improvement in quality of life may be obtained for those women whose pain is otherwise not adequately controlled. j