Show The second most common gynaecological condition in the UK often goes undiagnosed, leaving women with debilitating symptoms. Find out what to look out for, treatment options, plus when to refer patients Endometriosis is the second most commonly diagnosed gynaecological condition in the UK, after fibroids. Nursing Standard. 37, 9, 67-70. doi: 10.7748/ns.37.9.67.s21 Want to read more?Already subscribed? Log inORUnlock full access to RCNi Plus todaySave over 50% on your first 3 monthsYour subscription package includes:
Subscribe RCN student member? Try Nursing Standard StudentAlternatively, you can purchase access to this article for the next seven days. Buy now Or Section snippetsOverview of EndometriosisEndometriosis is a chronic, estrogen-dependent inflammatory disorder in which endometrial tissue grows outside the uterus. Common sites for growth include the ovaries, fallopian tubes, uterosacral ligaments, bladder, and bowel. Less frequently, endometrial tissue may be found in extrapelvic sites such as the diaphragm, umbilicus, and inguinal ligaments (Kuznetsov et al., 2017). The abnormal extrauterine tissue growth responds to the hormones of the menstrual cycle, and endometrial implants can SymptomsWomen with endometriosis may have a wide range of clinical manifestations, and often the severity of the symptoms does not correlate with the degree of the disease. These symptoms can lead to an overall decreased quality of life, thus increasing the risk of psychosocial complications in addition to physical symptoms (DiVasta et al., 2018; Kuznetsov et al., 2017). DiagnosisThe diagnosis of endometriosis can be challenging because although pelvic pain and dysmenorrhea are hallmark symptoms, pain alone is insufficient for the diagnosis of endometriosis, and the stage of the disease does not necessarily correlate with the severity of a woman’s symptoms (Agarwal et al., 2019). For these reasons, women often experience a delay in diagnosis of up to 8 to 10 years (Kiesel & Sourouni, 2019). Adenomyosis, a condition in which endometrial tissue infiltrates the myometrium, TreatmentThe only definitive treatment for endometriosis is removal of all endometrial implants as well as removal of the uterus, with or without removal of the ovaries (Chapron et al., 2019). Because this is not an option for women who want to preserve their fertility, medical management and conservative surgery are common treatment modalities. A summary of pharmaceutical management options is presented in Table 1. Pharmaceutical TreatmentInitial medical treatment for endometriosis-related pain typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen (Kuznetsov et al., 2017). These drugs reduce the production of prostaglandin and may reduce inflammation, menstrual cramping, and mild to moderate pelvic pain. However, no one NSAID has been identified as superior, and results vary among women. NSAIDs are often one of the first-line treatments, but their use may not result in Surgical TreatmentThere are several surgical options used for the treatment of endometriosis. In the majority of cases, surgical treatment is considered when medical management has been unsuccessful in controlling symptoms or when a woman is seeking pregnancy. Conservative surgical approaches involve destruction of superficial endometrial lesions. Conservative surgery is not curative, and pain will most likely recur with or without the presence of new endometrial implants (As-Sanie et al., 2019; Kuznetsov Surgery and FertilityCurrent treatment for preserving fertility is focused on improving the low fecundity rate and restoring normal pelvic anatomy (Llarena et al., 2019). However, whether the removal of endometrial implants improves the chance of conception and reduces early pregnancy loss is unclear (Benoit et al., 2019). Use of pharmaceuticals before surgery may decrease the size of the lesions and improve surgical outcomes, thereby improving fertility. Ovulation induction, superovulation, and in vitro Nurses who work in primary care or outpatient settings are well positioned to support women with endometriosis. First, nurses may facilitate collection of a subjective history, which will help establish a diagnosis. Although a surgical procedure is the gold standard for diagnosis (Nisenblat, Bossuyt, et al., 2016; Nisenblat, Prentice, et al., 2016), thorough history taking may help ameliorate the nearly decade-long delay many women experience in obtaining a diagnosis of endometriosis (Kiesel & ConclusionEndometriosis is a chronic condition that can result in pain, menstrual changes, and infertility. These symptoms can have a negative impact on psychosocial function and quality of life (DiVasta et al., 2018). Although future research must be conducted to improve the diagnosis and management of endometriosis, nurses will always play an integral role in the assessment, treatment, and support of women with this condition. A holistic approach to health care, in conjunction with an individualized Emily Keeler, RN, is a registered nurse in the intensive care unit at the University of Connecticut John Dempsey Hospital in Farmington, CT. Recommended articles (6)Emily Keeler, RN, is a registered nurse in the intensive care unit at the University of Connecticut John Dempsey Hospital in Farmington, CT. Heidi Collins Fantasia, PhD, RN, WHNP-BC, is an associate professor in the Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA; ORCID: 0000-0002-7646-1183. Brenna L. Morse, PhD, RN-BC, NCSN, CNE, is an assistant professor in the Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA. |
