Kein Folientitel

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Sites of Endometriosis
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? A dark endometrial implant in the vaginal wall.
? Implants of endometriosis on the surface of
the ovary
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? Ovarian endometrioma
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Diagnosis (3) - Laparoscopy

• Generally used to confirm diagnosis hallmarks
  of the disease are peritoneal or retroperitoneal
  implants, adhesions and endometriomas
• Lesions may be seen
• typical pigmented, dark, powder-burn nodules
• atypical non-pigmented, clear, white, red
  flame-like, yellow-brown nodules

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Diagnosis (3a) Laparoscopy
Patient A Characteristic powder-burn lesion
viewed on the surface of the uterus using
laparoscopy
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Diagnosis (3b) Laparoscopy
Patient B Ovary and fallopian tube identifiable
in this laparoscopy image
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Diagnosis (3c) Laparoscopy
Patient C Flame-like lesion viewed on the surface
of the uterus using laparoscopy
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? Implants on the surface of the peritoneum ?
Ovarian endometrioma ? Lesions in the pouch of
Douglas
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Hormonal Therapy GnRH agonistsDecapeptyl

• Mode of action
• Suppression of the hypothalamic-pituitary gonad
  axis
• Starving of the endometrial tissue by blocking
  oestrogen and progesterone

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• Hormonal Therapy
• GnRH agonists - Decapeptyl
• Efficacy
• Relief of pain in approx. 90 of all patientsA
  comparative trial (triptorelin vs placebo) from
  Bergquist et al.,1998 confirmed that this is due
  tothe action of DecapeptylDepot
• Reduction of the size of endometriomas by 50
  within 3 months

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Add-back therapy Rationale