Early diagnosis and avoiding unnecessary surgeries: two key issues
A paper presented by Dr. Pere Barri Soldevila, Head of the Endometriosis Unit of Dexeus Mujer at the 27th National Congress of the STGO and 19th Congress of the FEMGO suggests that delayed diagnosis and unnecessary surgeries in young women with endometriosis may be more harmful to the preservation of their future fertility than the condition itself. In addition, the decision to carry out a surgical intervention or to resort to assisted reproduction to solve infertility problems can sometimes depend on the speciality of the first doctor to examine the patient.
Therefore, it is essential that specialists receive the necessary training to improve the detection of endometriosis in young women. In general, in the presence of the triad of non-cyclic abdominal pain, treatment-refractory dysmenorrhoea and absenteeism from school or other daily activities, the probability of endometriosis is 70%.
Unlike in adult patients, in adolescents, 40% of cases remit spontaneously. However, the delay in diagnosis is generally higher (average of 11 years). The first treatment option should be pharmacological, e.g.: the combined oral contraceptive pill (COC), the Mirena IUD if the patient is older than 17, other hormone treatments (GnRH-a) and/or anti-inflammatory drugs (NSAIDs). Before resorting to surgery, it is necessary to weigh the advantage of preventing future endometriosis lesions against the possible risks of invasive procedures.
As regards endometriosis-related infertility problems, the message should be reassuring, as medical treatment has proven effective in the long term, keeping the disease in its early stages in 69% of cases. In terms of recommendations, the team says that it is important to monitor these patients and to inform them of the possible risks of delaying maternity. Also, before starting any kind of treatment, it is necessary to determine the patient's ovarian reserve, to find out if she intends to become pregnant in the short or long term and to discuss her options, including egg preservation.
Oral communication: Prise en charge de l’endometriose chez l’adolescente (Management of endometriosis in adolescent girls).
Pere N. Barri Soldevila, Carlota Vilarrubí, Nuria Barbany, Ignacio Rodriguez