Endometriosis: An Overview of the Disease and Its Treatment

Endometriosis: An Overview of the Disease and Its Treatment

from Journal of the American Pharmaceutical Association

Evaluation and Diagnosis

Diagnosing endometriosis can be difficult, because common presenting symptoms, such as pelvic pain or infertility, havenumerous causes and the disease may mimic a host of other disorders. During the physical examination, the physician maynotice positive signs of the disease, such as tender masses or nodules that may be detected on palpation of the upper vagina,cul-de-sac, uterosacral ligaments, or rectovaginal septum. However, these signs are neither specific nor diagnostic ofendometriosis and, at present, no simple noninvasive technique is available for diagnosing this disease.[6]

Currently, the "gold standard" for diagnosis is direct visualization of endometrial lesions using laparoscopy, often withconfirmation by biopsy of excised endometriotic tissue.[7] During laparoscopy, the extent andseverity of disease can be determined, after which the disease can be classified. According to the American Fertility SocietyClassification of Endometriosis, the disease can be minimal (Stage I), mild (Stage II), moderate (Stage III), or severe (StageIV).[36] Minimal disease consists of only a few small lesions on the peritoneum or ovary, alongwith some filmy adhesions. More severe cases may involve multiple lesions on the peritoneum, invasive lesions or cysts, anddense adhesions that affect the ovaries, fallopian tubes, GI system, urinary tract, or more distant organs.

Although a specific noninvasive test is not yet available for diagnosing endometriosis, researchers have discovered thatpatients with advanced endometriosis have higher blood levels of CA-125, a cell surface protein. Measurement of CA-125levels is not sensitive enough to detect minimal or mild endometriosis. Also, elevated CA-125 levels occur in many otherconditions, such as ovarian cancer, pregnancy, menses, and pelvic inflammatory disease.[7,37]Nonetheless, the concentration of CA-125 has been correlated with the severity and clinical course of endometriosis. Risinglevels of this serum marker over time indicate disease progression; declining levels indicate lesion regression. Monitoring ofserial CA-125 levels may therefore provide clinicians with additional information about the status of endometriosis and theefficacy of treatment.[38]

Pelvic ultrasound is another procedure that may be used to help detect endometriosis. Although its use is limited by itsnonspecificity, ultrasound can be useful in detecting large endometriomas and in monitoring the size of an endometrioma inresponse to therapy.[39]

This is a part of article Endometriosis: An Overview of the Disease and Its Treatment Taken from "Aygestin Norethindrone Acetate" Information Blog