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Laparoscopic evaluation of the onset and progression of endometriosis

  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Kinki University School of Medicine
    Hiroshi Hoshiai
    Correspondence
    Reprint requests: Hiroshi Hoshiai, MD, Department of Obstetrics and Gynecology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan 589.
    Footnotes
    a From the Department of Obstetrics and Gynecology, Kinki University School of Medicine
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  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Kinki University School of Medicine
    Motoharu Ishikawa
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    a From the Department of Obstetrics and Gynecology, Kinki University School of Medicine
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  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Kinki University School of Medicine
    Yoshiharu Sawatari
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    a From the Department of Obstetrics and Gynecology, Kinki University School of Medicine
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    a From the Department of Obstetrics and Gynecology, Kinki University School of Medicine
    Kichiro Noda
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    a From the Department of Obstetrics and Gynecology, Kinki University School of Medicine
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  • Author Footnotes
    b Tohoku University School of Medicine
    Takao Fukaya
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    b Tohoku University School of Medicine
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  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Kinki University School of Medicine
    b Tohoku University School of Medicine
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      Objective: To clarify the pathogenesis of endometriosis on the basis of analysis of primary lesion sites, age at onset, rate of progression, and response to drug treatment.
      Study Design: The clinical records of 690 women with laparoscopically confirmed endometriosis were retrospectively analyzed based on the revised American Fertility Society point system.
      Results: The primary site of endometriosis was the uterosacral ligament and pelvic peritoneum/pouch of Douglas in 73% of patients with stage I disease, whereas only 16% had ovarian lesions. However, disease progression was associated with an increasing frequency of ovarian lesions. In terms of the revised American Fertility Society score, endometriosis progressed at a mean rate of 0.3 point per month. Thus the earliest onset of endometriosis was estimated at 3 to 4 years after menarche. Drug therapy improved the revised American Fertility Society score by about 50%. Patients with a low response to an initial cycle of therapy generally showed further improvement after an additional treatment cycle.
      Conclusions: Because endometriosis may occur as early as 3 to 4 years after menarche and gradually progresses, drug therapy, including long-term treatment, should be carried out in women with definitive evidence of endometriosis who must maintain their reproductive potential.

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