A 43-year-old woman who has endometriosis is admitted to a hospital with what is thought to be associ¬ated partial left-colon obstruction. The treatment of choice is
|D||administration of danazol|
a. Radical surgery involves total hysterectomy with bilateral oophorectomy (TAH-BSO) and cytoreduction of visible endometriosis.
b. Adhesiolysis is performed to restore mobility and normal intrapelvic organ relationships.
c. Ureteric obstruction may warrant surgical release or excision of a damaged segment.
d. Bowel obstruction may require a resection anastomosis or a wedge resection if the obstruction is confined to the anterior rectosigmoid
e. In case of this patient there is only partial obstruction to the colon and hence hormonal therapy can to tried to reduce the endometriotic load and treat obstruction conservatively.
f. Danazol acts by inhibiting the midcycle follicle-stimulating hormone (FSH) and luteinizing hormone (LH) surges and preventing steroidogenesis in the corpus luteum. It is the most extensively studied agent for endometriosis.
g. Danazol has been shown to be as effective as any of the newer agents, but with a higher incidence of adverse effects.
h. Its androgenic manifestations include oily skin, acne, weight gain, deepening of the voice, and facial hirsutism.
i. Hypoestrogenic features due to danazol include emotional lability, hot flashes, vaginal dryness, and reversible breast atrophy.
j. The recommended dose is 600-800 mg/d. However, smaller doses have been used with success.