Endometriosis: An Evidence-Based Clinical Intervention
Medical Problem: Endometriosis is a chronic, estrogen-dependent, inflammatory disease characterized by the presence of endometrial-like tissue outside the uterus, leading to chronic pain, menstrual irregularities, and infertility (Dunselman et al., 2014).
Typical Presenting Signs and Symptoms: The typical symptoms of endometriosis include pelvic pain, painful menstrual periods, dyspareunia, and infertility. The pain associated with endometriosis can be cyclic or non-cyclic and can occur at any time in the menstrual cycle. Other associated symptoms include gastrointestinal disturbances, such as bloating, nausea, and diarrhea, and genitourinary symptoms such as dysuria, hematuria, and urinary frequency. The usual age group affected is reproductive-aged women, with an estimated prevalence of 6-10% (Dunselman et al., 2014).
Pathophysiology: Endometriosis results from the ectopic growth of endometrial-like tissue outside the uterus. The exact pathophysiology of endometriosis is not fully understood. However, several theories suggest that retrograde menstruation, lymphatic and hematogenous spread, and coelomic metaplasia are the possible mechanisms underlying endometriosis development (Burney & Giudice, 2012).
- Pelvic Inflammatory Disease (PID): presents with lower abdominal pain, fever, and vaginal discharge. Fever is the most important distinguishing factor from endometriosis.
- Ovarian Cyst: presents with lower abdominal pain, bloating, and changes in bowel or bladder habits. Presence of a palpable mass on pelvic examination distinguishes ovarian cyst from endometriosis.
- Adenomyosis: presents with painful menstrual periods, heavy bleeding, and an enlarged, tender uterus. A uterus that is diffusely enlarged and tender is the hallmark feature of adenomyosis (Brosens et al., 2013).
Evidence-Based Practice for Endometriosis: According to a study conducted by Nisenblat et al. (2019), laparoscopic excision surgery is the most effective treatment for endometriosis in terms of reducing pain and improving fertility. The study found that laparoscopic surgery significantly reduced pain symptoms and improved quality of life. In addition, surgical treatment was found to be more effective than hormonal therapy in terms of pain relief and fertility improvement.
Expected Outcomes: The expected outcomes of laparoscopic excision surgery in endometriosis patients are reduced pain symptoms and improved quality of life. Patients may also experience improved fertility outcomes following surgery (Nisenblat et al., 2019).
Algorithms: The American Society for Reproductive Medicine (ASRM) has developed an algorithm to guide the management of endometriosis, which includes medical and surgical options depending on the patient’s symptoms, age, and fertility desires (Johnson et al., 2012).
SOAP Note: S: A 30-year-old female presents with chronic pelvic pain, dyspareunia, and heavy menstrual periods for the past 3 years. O: Pelvic examination reveals tenderness in the left adnexal area. No palpable masses or uterine enlargement noted. Transvaginal ultrasound shows an endometrioma in the left ovary measuring 4 cm. A: Endometriosis, differential diagnosis includes ovarian cyst and pelvic inflammatory disease. P: Laparoscopic excision surgery to remove endometriotic implants and the endometrioma is recommended based on the patient’s symptoms and ultrasound findings.