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  #1  
Old 02-08-2012
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ObGyn Treatment of Endometriosis

17 year old G0 with dysmennorhea secondary to moderate endopmetriosis. started on OCPs for 10 weeks.. On follow up, only mild relief of symptoms. Next best therapy is :-

A. Dexamethasone
B. Electrocautery, endocoagulation or laser resection
C. Leuprolide
D. Progestin only
E. Unopposed Estrogens
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  #2  
Old 02-08-2012
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C. Leuprolide
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  #3  
Old 02-08-2012
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Gnrh analog C. Leuprolide
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Old 02-08-2012
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B, to maintain fertility.
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Old 02-08-2012
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Default Progesterone only

In order, I would try:
1. OCP + NSAID
2. Progesterone (e.g. depo-provera)
3. GnRH agonist (e.g. leuprolide)
4. maybe a gonadotropin inhibitor (e.g. danazol)
5. Then conservative surgery
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Old 02-08-2012
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the answer is C. source is 1st aid qbank. they put some really conflicting questions.

why not go for progestin only therapy... i mean according to kaplan and medscape, long acting progestin like DMPA are 1st line treatment...... leuprolide and danazol come later.... and surgical intervention in form of laser, etc comes at the end.... and the last is hysterectomy......
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Old 02-08-2012
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http://emedicine.medscape.com/articl...#aw2aab6b6b1aa

Medical vs surgical therapy
In women who wish to preserve their reproductive potential, the rates of recurrent pain symptoms are 44% with surgical management and 53% with medical management.[50, 51]

Endometriosis and subfertility
Peritubal and periovarian adhesions can interfere mechanically with ovum transport and contribute to subfertility. Peritoneal endometriosis has been postulated to contribute to subfertility by interfering with tubal motility, folliculogenesis, and corpus luteum function. Aromatase is believed to increase the prostaglandin E levels via increase in the cyclooxygenase-2 (COX-2) expression. Endometriosis may also cause subfertility by causing more sperm binding to the ampullary epithelium, thereby affecting sperm-endosalpingeal interactions.[52]

Medical treatment of minimal or mild endometriosis has not been shown to increase pregnancy rates.[53] Moderate to severe endometriosis should be treated surgically.[54]

So Conservative Surgery to remove endometrial tissues must be the answer..
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Old 02-08-2012
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Quote:
Originally Posted by drnrpatel View Post
http://emedicine.medscape.com/articl...#aw2aab6b6b1aa

Medical vs surgical therapy
In women who wish to preserve their reproductive potential, the rates of recurrent pain symptoms are 44% with surgical management and 53% with medical management.[50, 51]

Endometriosis and subfertility
Peritubal and periovarian adhesions can interfere mechanically with ovum transport and contribute to subfertility. Peritoneal endometriosis has been postulated to contribute to subfertility by interfering with tubal motility, folliculogenesis, and corpus luteum function. Aromatase is believed to increase the prostaglandin E levels via increase in the cyclooxygenase-2 (COX-2) expression. Endometriosis may also cause subfertility by causing more sperm binding to the ampullary epithelium, thereby affecting sperm-endosalpingeal interactions.[52]

Medical treatment of minimal or mild endometriosis has not been shown to increase pregnancy rates.[53] Moderate to severe endometriosis should be treated surgically.[54]

So Conservative Surgery to remove endometrial tissues must be the answer..

I agree, that's why i chose B, but apparently the answer is C, any explanations anyone?
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Old 02-09-2012
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Quote:
Originally Posted by HouseWannabe View Post
I agree, that's why i chose B, but apparently the answer is C, any explanations anyone?
Simply,

Whats cheaper? in B, you have to do surgery, risk infection, risk infertility.

In C- its an easy 1 shot for 3 months. It calms down the female organs, causing no pain. Fertility is still maintained after you go off the shot. Its easier, cheaper and no risk of infections.


C
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  #10  
Old 02-10-2012
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answer is c........
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  #11  
Old 08-15-2012
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First line therapy is oral progesterone or OCPs but she is already taking OCPs which are not quite working as she still has dysmennorhea,hence the second line of treatment which includes testosterone derivatives like danazol or Gnrh analogs like leuprolide need to be used. surgical procedures like TAH and BSO are done when fertility is not desired but as she is 17 this could not be done.So the correct answer is C (leuprolide).
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