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Endometriose

Sist revidert:
Sist revidert av:


Definisjon:
Endometrieliknendevev utenfor uterinhulen. Inflammatorisk tilstand. Sykdomsaktivitet stimuleres av østrogen
Forekomst:
6-10% i den generelle fertile kvinnelige befolkningen.
Symptomer:
Dysmenore, lave magesmerter og kraftig mensblødning. Ev. dysuri og/eller defekasjonssmerter under menstruasjon, obstipasjon, diare, dyp dyspareuni, kvalme
Funn:
Klinisk undersøkelse er ofte normal. Viktige funn ved bimanuell palpasjon er øm oppfylning over adnex/bak cervix, nedsatt mobilitet av uterus
Diagnostikk:
Effekt av empirisk hormonell behandling og NSAID (primærhelsetjenesten). Ev. transvaginal UL og ev. laparoskopi.
Behandling:
Symptomatisk behandling med NSAIDs, empirisk hormonell behandling.Kirurgi ved manglende effekt av hormoner eller funn av omfattende endometriose. Ev. assistert befruktning ved infertilitet
  1. Majak GB. et al. Endometriose og adenomyose. Norsk gynekologisk forening Veileder i gynekologi (2021). ePub. ISBN 978-82-692382-1-1. Siden besøkt 12.10.2021 www.legeforeningen.no  
  2. Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010 Jun 24;362(25):2389-98. PMID: 20573927. PubMed  
  3. Moen MH, Stokstad T. A long-term follow-up study of women with asymptomatic endometriosis diagnosed incidentally at sterilization. Fertil Steril. 2002 Oct;78(4):773-6. PMID: 12372455.
  4. Vercellini P, Vigano P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 2014; 10: 261-75. pmid:24366166 PubMed  
  5. Kuznetsov L, Dworzynski K, Davies M, Overton C. Guideline Committee. Diagnosis and management of endometriosis: summary of NICE guidance. BMJ 2017; 358: j3935. pmid:28877898 PubMed  
  6. Abou-Setta AM, Houston B, Al-Inany HG, Farquhar CM. Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database of Systematic Reviews 2013; 1: CD005072. The Cochrane Library  
  7. Vercellini P, Frontino G, De Giorgi O et al. Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study. Fertil Steril. 2003 Aug;80(2):305-9. PMID: 12909492. PubMed  
  8. Vercellini P, Buggio L, Frattaruolo MP et al. Medical treatment of endometriosis-related pain. Best Pract Res Clin Obstet Gynaecol. 2018 Aug;51:68-91. PMID: 29530425. PubMed  
  9. Vercellini P, Bracco B, Mosconi P et al. Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. Fertil Steril. 2016 Mar;105(3):734-743.e3. Epub 2015 Dec 8. PMID: 26677792. PubMed  
  10. Walch K, Unfried G, Huber J et al. Implanon versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis--a pilot study. Contraception. 2009 Jan;79(1):29-34. Epub 2008 Sep 25. PMID: 19041438. PubMed  
  11. Bedaiwy MA, Casper RF. Treatment with leuprolide acetate and hormonal add-back for up to 10 years in stage IV endometriosis patients with chronic pelvic pain. Fertil Steril. 2006 Jul;86(1):220-2. Epub 2006 May 23. PMID: 16716325. PubMed  
  12. Langebrekke A, Johannessen H-O, Qvigstad E. Kirurgisk behandling av endometriose. Tidsskr Nor Legeforen 2008; 128: 1515-8. PubMed  
  13. de Bruijn AM, Smink M, Lohle PNM et al. Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol. 2017 Dec;28(12):1629-1642.e1. Epub 2017 Oct 9. PMID: 29032946. PubMed  
  14. Banerjee SK, Ballard KD, Wright JT. Endometriomas as a marker of disease severity. J Minim Invasive Gynecol. 2008 Sep-Oct;15(5):538-40. Epub 2008 Jul 10. PMID: 18619924. PubMed  
  15. Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD004992. DOI: 10.1002/14651858.CD004992.pub3. DOI  
  16. Johnson NP, Hummelshoj L. Reply: consensus on current management of endometriosis. Hum Reprod. 2013 Nov;28(11):3163-4. Epub 2013 Sep 5. PMID: 24014602. PubMed  
  17. Jacobson TZ, Duffy JM, Barlow D, et al. Laporoscopic surgery for subfertility associated with endometriosis. Cochrane Database of Systematic Reviews 2010; 1: CD001398. Cochrane (DOI)  
  18. Chen YJ, Hsu TF, Huang BS, et al. Postoperative maintenance levonorgestrel-releasing intrauterine system and endometrioma recurrence: a randomized controlled study. Am J Obstet Gynecol 2017; 216: 582.e1-582.e9. pmid:28209488 PubMed  
  19. Zhu X, Hamilton KD, McNicol ED. Acupuncture for pain in endometriosis. Cochrane Database of Systematic Reviews 2011; 9: CD007864. Cochrane (DOI)  
  20. Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ. 2014 ;348:g1752. doi: 10.1136/bmj.g1752 DOI  
  21. Schwartz A, Wölfler MM, Mitter V et al. Endometriosis espesially mild disease a risk factor for misscarriages. Fertil Steril 2017;108:5:806-14. PMID: 29079275 PubMed  
  • Ingrid Marie Ringen, spesialist i kvinnesykdommer og fødselshjelp, overlege, seksjon for generell gynekologi, Kvinneklinikken, St. Olavs hospital Trondheim
  • Silje Folven Barlindhaug, spesialist i allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Mette Haase Moen, førsteamanuensis ved Norges teknisk-naturvitenskapelige universitet og overlege ved Kvinneklinikken St. Olavs Hospital, Trondheim