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Endometriosis has evolved from a disease of anatomic pathologic observation followed by empiric therapy. Currently molecular mechanisms of disease are the primary area of investigation. In this sympsoium, all aspects of endometriosis are addressed because all are important in understanding the disease, treating the disease, and having a vision toward future improvements in patient management. The ultimate goal of precision medicine. It is hypothesized that there are many forms of endometriosis that will be discovered over time utilizing GWAS Genetic Testing to profile patients as far as the etiology is concerned. Once this goal is achieved medications can be developed that specifically treat the endometriosis in individual patients.
This does not mean that old insights and therapies are not important. Surgery has an important role in alleviating pain, although it does not seem to be significant in treating patients with infertility, unless adhesions and scarring of the pelvic organs is apparent.
Although well-trusted medications still have an important role for pain: Danocrine, Lupron, continuous birth control pills and aromatase inhibitors all have their role. In regard to fertility, ovulation induction with Clomid, Gonadotropins and Letrozole also have an important role in treating patients before needing in vitro fertilization.
Understanding the pathophysiology certainly is important in explaining to patients why they have endometriosis. The frequency of retrograde menstruation, the inability of macrophage activity to be uniform in all patients and of course the role of aromatase in ectopic endometrial tissue. New information about inflammation and it its ubiquitous ramifications in regard to disease is also an important concept to be mastered in regard to endometriosis and sequela.
All of these concepts are important, but the bottom line is the effect that endometriosis has on patients and how best to understand and treat these phenomena. This is a common cause of infertility occurring in approximately 20% of the population. Why some patients with endometriosis have infertility and others do not will be addressed. Most perplexing is the patient with endometriosis with chronic pelvic pain; with current day therapies falling short of expected relief. The vision for the future must be considered because this is where our promise is held and this includes genetics, genetic manipulation, epigenetic information and understanding in regard to this serious disease.
All of these aspects are included in this symposium with current information and insight.
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