Endometriosis

Dear Editor,

I would like to thank Drs Malarselvi and Irani (Birmingham), Overton
and Park (Bristol) and Smith (Sheffield) for their comments on our article.

We
agree that there is no correlation between severity of disease and
symptoms. Although diagnostic laparoscopy is considered by many as the
“gold standard” investigation, as we have pointed out this depends on the
person doing the procedure and the timing of the procedure. Reliance on
diagnostic laparoscopy alone will result in the condition being under-diagnosed. The article is aimed at primary as well as secondary care.

Emphasis should therefore we feel be on clinical features. Under ideal
circumstances, GnRH agonist should not be recommended to girls under the
age of 17 years but this must be balanced against the severity of her
symptoms and the benefits of treatment.

Drs Overton and Park have enriched our article with their comments and
we are grateful to them. They are right about the typographical error in
the case scenario. GnRH agonists are not pills but nasal sprays or
injections.

While malignancies are recognise to arise from endometriosis, the
condition cannot be considered a malignancy. It is a benign condition
which behaves in some cases like a malignancy. The argument as advanced by
Dr Smith that simply because a condition may progress to a neoplasia is
not enough to label the pathology a neoplasia as there are other benign
pathologies that progress to malignancy but are not labelled neoplastic.

Competing interests:
JCK has an ongoing research programme funded by Bayer on the use Mirena and decapeptyl in the management of symptoms of endometriosis.