Populasi Khusus

Endometriosis paling sering didiagnosis pada wanita berusia tiga puluhan dan empat
puluhan, tetapi endometriosis adalah diagnosis paling umum pada pasien remaja yang
mengalami dismenore sekunder.15 Endometriosis umumnya muncul sebagai tahap awal
pada remaja, sehingga temuan fisik seringkali normal dan temuan laparoskopi mungkin tidak
atipikal dibandingkan dengan yang terlihat pada wanita yang lebih tua
Pengobatan pasien remaja mirip dengan pedoman pengobatan orang dewasa, dengan
perbedaan yang paling mencolok terkait dengan penggunaan pilihan yang mempengaruhi
kepadatan mineral tulang (BMD).15,28,45 Baik DMPA dan agonis GnRH harus digunakan
dengan hati-hati pada remaja karena untuk kekhawatiran kehilangan BMD dan sementara
mereka tidak sepenuhnya dikontraindikasikan, penggunaannya harus ditunda selama
mungkin dan hanya dimulai setelah pertimbangan penuh dari profil risiko/manfaat.45
Dismenore pada remaja biasanya diobati secara empiris dengan pilihan lini pertama
termasuk NSAID dan CHC. Ini dapat diuji coba selama 3 bulan untuk menilai pereda nyeri.
Jika nyeri berlanjut setelah 3 bulan, CHC dapat diubah dari dosis siklik ke dosis kontinu
untuk memicu amenore. Langkah berikutnya setelah kegagalan opsi lini pertama ini
biasanya mencakup pertimbangan pembedahan diagnostik/pengobatan laparoskopi karena
kegagalan sangat berkorelasi dengan diagnosis endometriosis.
EVALUASI HASIL TERAPI
Pemantauan hasil untuk endometriosis didasarkan pada pengurangan gejala yang
subjektif. Faktor-faktor seperti ukuran, jumlah, dan distribusi lesi endometrium tidak
berkorelasi dengan gejala nyeri atau potensi kesuburan, membatasi penggunaan tes objektif
untuk mengukur respons terhadap pengobatan.
Kuesioner Kepuasan Pengobatan Endometriosis adalah instrumen hasil yang dilaporkan
pasien yang dikembangkan dan divalidasi untuk mengukur nyeri yang dilaporkan pasien
sebelum dan/atau selama periode, nyeri selama dan/atau setelah berhubungan seks, nyeri
endometriosis, perdarahan dan bercak, tolerabilitas, dan kepuasan keseluruhan
menggunakan skala Likert tujuh poin. Alat lain yang divalidasi adalah Medical Outcomes
Study Questionnaire Short Form 36 Health Survey (SF-36).2,46,47
Perawatan medis endometriosis harus meredakan nyeri terkait endometriosis dalam
waktu 2 bulan setelah inisiasi. Jika gejala tidak berkurang, individu dapat mencoba pilihan
medis lain dan/atau pembedahan.
Pembedahan sering diperlukan pada infertilitas terkait endometriosis. Direkomendasikan
bahwa individu membiarkan 6 bulan pasca intervensi untuk mencoba untuk hamil. Jika
kehamilan tidak tercapai dalam rentang waktu ini, teknologi reproduksi berbantuan adalah
pengobatan berikutnya.
KESIMPULAN
 Endometriosis adalah penyakit umum dengan implikasi mulai dari rasa sakit dan
penurunan kualitas hidup hingga infertilitas. Modalitas pengobatan tidak kuratif tetapi
mungkin berhasil mengurangi ketidaknyamanan dan meningkatkan kualitas hidup. Rencana
perawatan harus dirancang dengan mempertimbangkan faktor dan tujuan spesifik pasien.

Aktivitas Pembelajaran Terlibat Pasca Kelas

Lakukan pencarian literatur obat untuk perawatan endometriosis yang saat ini sedang
dalam pengembangan obat dan jelaskan mekanisme kerjanya. Menggunakan pengetahuan
Anda tentang patofisiologi endometriosis, target terapi obat apa yang mungkin?

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