Management Challenges of Deep Infiltrating Endometriosis

Document Type : Review Article

Authors

1 Department of Surgical Sciences, University of Cagliari, Cagliari, Italy

2 Department of Obstetrics and Gynecology, Tanta University, Tanta, Egypt

3 Department of Obstetrics and Ginecology, ‘Valle d’Itria’ Hospital, Martina Franca, Taranto, Italy

4 Department of Obstetrics and Gynecology, 2nd University Clinic of Obstetrics and Gynecology, Aristotele University of Thessaloniki, Thessaloniki, Greece

5 Department of Surgical Sciences, University of Cagliari, Cagliari, Italy;

Abstract

Deep infiltrating endometriosis (DIE) is the most aggressive of the three phenotypes that constitute endometriosis.
It can affect the whole pelvis, subverting the anatomy and functionality of vital organs, with an important negative
impact on the patient’s quality of life. The diagnosis of DIE is based on clinical and physical examination, instrumental
examination, and, if surgery is needed, the identification and biopsy of lesions. The choice of the best therapeutic
approach for women with DIE is often challenging. Therapeutic options include medical and surgical treatment, and
the decision should be dictated by the patient’s medical history, disease stage, symptom severity, and personal choice.
Medical therapy can control the symptoms and stop the development of pathology, keeping in mind the side effects
derived from a long-term treatment and the risk of recurrence once suspended. Surgical treatment should be proposed
only when it is strictly necessary (failed hormone therapy, contraindications to hormone treatment, severity of symptoms,
infertility), preferring, whenever possible, a conservative approach performed by a multidisciplinary team. All
therapeutic possibilities have to be explained by the physicians in order to help the patients to make the right choice
and minimize the impact of the disease on their lives.

Keywords

References

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International Journal of Fertility and Sterility
Volume 15, Issue 2
April 2021
Pages 88-94

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