In America, every 4.5 years, approximately 20,000 US women have an endometrioma. The number of women with endometrioma increases as they age, with 15.1% of women aged 50-59 having an endometrioma compared to 35.1% of women aged 60-64, 39.3% of women aged 65-67, and 43.3% of women 70 years and older having an endometrioma. On average each woman with an endometrioma living in America will have the disease for about five years.
Endometrioma can be completely removed in many cases. However, cure is a rare occurrence. The overall chance of a good cosmetic result after surgery is greater than chance of cure and less than chance of severe complication or recurrence.
We recommend surgical excision of endometriomas based on clinical indications. The use of anti-inflammatory and estrogen-only hormonal therapy are associated with a more benign type of recurrence.
Pain is the chief complaint that reflects deep endometrioma. On physical examination, a palpable, nontender uterus, and a palpable, rubbery, mobile uterus is the nonspecific finding that could reflect endometrioma. A palpable painless and red uterus with tenderness in the suprapubic area with or without vaginal bleeding, and a palpable red and tender uterus in the lower quadrant are highly suggestive of endometrioma. The presence of bleeding and the presence of pain during intercourse can also suggest endometrioma. The presence of pelvic adhesions and other nonspecific findings during vaginal examination do not exclude endometrioma.
Findings from a recent study from this study indicated that, endometrioma is not simply the result of implantation of tissue from the pelvic cavity. Endometrioma appears to be caused not only by hormonal changes, but also by other factors associated with the development of endometriosis.
Endometrioma represents an uncommon intra abdominal benign tumor and is the second most common gynaecological adnexal lesion. The main cause of endometriosis is unopposed estrogen action on endometrial tissue following the ovulation, and the presence of endometrioma is a predisposing factor of endometriosis. The diagnosis of endometrioma is often made by pelvic examination, especially when the endometrioma consists of an enlarged glandular area.
It is concluded that the present data suggest that the combination of 20/estrogens/bazedoxifene is of special interest in patients with symptomatic endometriosis whose pain becomes refractory to antiestrogen therapy alone, while the present data also confirm that the addition of testosterone 0.45mg tb has no further advantage as compared with the combination of 20/estrogens/bazedoxifene in these patients; for this reason, the use and maintenance of testosterone 0.45mg tb should not be considered in all patients with symptomatic endometriosis as an alternative to bazedoxifene 20/estrogens.
Bazedoxifene 20/CE,con 0.45 mg tb significantly reduces severity of illness for patients with endometrioma and positively affects QoL. The reduction of disease-related pain,surgical indications and the overall disease severity with this regimen seem to be due to a hormonal effect of estrogen on endometrial tissue rather than from a direct effect on endometrioma.
Bazedoxifene 1 mg/25mg tb +con 0.45 mg tb +con 0.05 mg orcon 0.25 mg tb are safe, effective with no adverse effects, and can help women with endometriosis.
In terms of effectiveness and tolerability, bazedoxifene 20/estrogen combination therapy should be preferable and should be considered a cornerstone treatment for endometriosis if there are no contraindications.
Women who have had multiple surgical or radiologic interventions for endometriosis have a similar frequency of histological endometrioma at the time of referral to and completion of the trial. Therefore, clinical trials should not be withheld from this subset of women with endometriosis who are willing to participate in a trial of this intervention, but only after careful consideration. Those who do not wish to be included in an endometrioma clinical trial should not be denied the opportunity to participate and should be encouraged when it is not possible to include them.