Overview of the Effect of Complementary Medicine on Treating or Mitigating the Risk of Endometriosis.

OBJECTIVE: Endometriosis is a hormone-dependent chronic inflammatory disease with symptoms such as pelvic pain, which affect the physical, emotional, and social health of women in reproductive age. The current overview article aims to explore the effect of complementary medicine on the treatment or in mitigating the risk of endometriosis. METHODS: This is an overview article done in Iran. Two separate researchers systematically searched 3 databases (Medline, Scopus, and Cochrane Central Register Trials) until September 2020. The methodological quality of each study was assessed using the assessment of multiple systematic reviews (AMSTAR) tool. RESULTS: The results of two reviews suggested that physical activity, tobacco smoking, diet, coffee and caffeine intake had no effect on mitigating the risk of endometriosis or improving its treatment, but acupuncture successfully reduced pain and related marker (serum CA-125) levels. CONCLUSION: As endometriosis is an annoying disease with many complications and is hard to diagnose and treat, related studies in complementary medicine can help patients with endometriosis. Based on the relevant literature review, among the complementary medicine available for the treatment or to mitigate the risk of endometriosis, only acupuncture seems to alleviate the pain of endometriosis.

OBJETIVO: A endometriose é uma doença inflamatória crônica hormono-dependente com sintomas como dores pélvicas, que afetam a saúde física, emocional e social de mulheres em idade reprodutiva. O presente artigo de visão geral tem como objetivo explorar o efeito da medicina complementar no tratamento ou na mitigação do risco de endometriose. MéTODOS: Trata-se de um artigo de visão geral feito no Irã. Dois pesquisadores separados pesquisaram sistematicamente 3 bancos de dados (Medline, Scopus e Cochrane Central Register Trials) até setembro de 2020. A qualidade metodológica de cada estudo foi avaliada usando a ferramenta avaliação da qualidade dos relatos de revisão sistemática (AMSTAR, na sigla em inglês). RESULTADOS: Os resultados de duas revisões sugeriram que atividade física, tabagismo, dieta, consumo de café e cafeína não tiveram efeito na redução do risco de endometriose ou na melhoria do tratamento, mas a acupuntura reduziu com sucesso a dor e os níveis de marcadores relacionados (CA-125 sérico). CONCLUSãO: Como a endometriose é uma doença incômoda, com muitas complicações e de difícil diagnóstico e tratamento, estudos relacionados em medicina complementar podem ajudar pacientes com endometriose. Com base na revisão da literatura relevante, entre os medicamentos complementares disponíveis para o tratamento ou risco de endometriose, apenas a acupuntura parece aliviar a dor da endometriose.

Overview of the Effect of Complementary Medicine on Treating or Mitigating the Risk of Endometriosis / Visão geral do efeito da medicina complementar no tratamento ou mitigação do risco de endometriose

Abstract Objective Endometriosis is a hormone-dependent chronic inflammatory disease with symptoms such as pelvic pain, which affect the physical, emotional, and social health of women in reproductive age. The current overview article aims to explore the effect of complementary medicine on the treatment or in mitigating the risk of endometriosis. Methods This is an overview article done in Iran. Two separate researchers systematically searched 3 databases (Medline, Scopus, and Cochrane Central Register Trials) until September 2020. The methodological quality of each study was assessed using the assessment of multiple systematic reviews (AMSTAR) tool. Results The results of two reviews suggested that physical activity, tobacco smoking, diet, coffee and caffeine intake had no effect on mitigating the risk of endometriosis or improving its treatment, but acupuncture successfully reduced pain and related marker (serum CA-125) levels. Conclusion As endometriosis is an annoying disease with many complications and is hard to diagnose and treat, related studies in complementary medicine can help patients with endometriosis. Based on the relevant literature review, among the complementary medicine available for the treatment or to mitigate the risk of endometriosis, only acupuncture seems to alleviate the pain of endometriosis.

Resumo Objetivo A endometriose é uma doença inflamatória crônica hormono-dependente com sintomas como dores pélvicas, que afetam a saúde física, emocional e social de mulheres em idade reprodutiva. O presente artigo de visão geral tem como objetivo explorar o efeito da medicina complementar no tratamento ou na mitigação do risco de endometriose. Métodos Trata-se de um artigo de visão geral feito no Irã. Dois pesquisadores separados pesquisaram sistematicamente 3 bancos de dados (Medline, Scopus e Cochrane Central Register Trials) até setembro de 2020. A qualidade metodológica de cada estudo foi avaliada usando a ferramenta avaliação da qualidade dos relatos de revisão sistemática (AMSTAR, na sigla em inglês). Resultados Os resultados de duas revisões sugeriram que atividade física, tabagismo, dieta, consumo de café e cafeína não tiveram efeito na redução do risco de endometriose ou na melhoria do tratamento, mas a acupuntura reduziu com sucesso a dor e os níveis de marcadores relacionados (CA-125 sérico). Conclusão Como a endometriose é uma doença incômoda, com muitas complicações e de difícil diagnóstico e tratamento, estudos relacionados em medicina complementar podem ajudar pacientes com endometriose. Com base na revisão da literatura relevante, entre os medicamentos complementares disponíveis para o tratamento ou risco de endometriose, apenas a acupuntura parece aliviar a dor da endometriose.

Uterine clinical findings, fertility rate, leucocyte migration, and COX-2 protein levels in the endometrial tissue of susceptible mares treated with platelet-rich plasma before and after AI.

Persistent mating-induced endometritis (PMIE) results in decreased fertility in horses, thereby causing a significant impact in the horse market. Platelet-rich plasma (PRP), a modulator of the inflammatory response, has been largely used in veterinary medicine. Here, we investigated the effects of PRP on uterine inflammation, conception rate, endometrial polymorphonuclear neutrophil (PMN) migration, and COX-2 protein levels in the endometrial tissue. Thirteen PMIE-susceptible mares were used for artificial insemination (AI). The mares were inseminated with fresh semen in three consecutive cycles in a cross-over study design. The following cycle classifications were used: control cycle, no pharmacological interference; pre-AI, 20 mL of PRP was infused 24 h before AI; and post-AI, 20 mL of PRP was infused four h after AI. Follicular dynamics were monitored daily by transrectal ultrasound. When a follicle larger than 35 mm was detected, ovulation was induced with deslorelin acetate (1 mg, im). AI was performed 24 h after ovulation induction. Intrauterine fluid (FLU) was evaluated by ultrasonography before and 24 h after AI. PMNs in uterine cytology (CYT) and biopsy (HIS) were also observed before and 24 h after AI. Pregnancy was determined within 14 days after ovulation. Number of COX-2 positive cells was evaluated by immunohistochemistry. Both PRP treatments resulted in a decrease of PMNs in the CYT after breeding when compared to controls. FLU did not differ between cycles; however, the conception rates were significantly higher in the PRP mares. Mares positive for endometritis decreased in both treatment groups, and a more intense positive COX-2 labeling was observed in the control group when compared to the two treatment groups. In conclusion, PRP beneficially reduces inflammatory response in PMIE mares independent of when treatments were administered, thus increasing chances of successful pregnancy.

N-Acetyl-Cysteine and l-Carnitine Prevent Meiotic Oocyte Damage Induced by Follicular Fluid From Infertile Women With Mild Endometriosis.

This study evaluated the potential protective effect of the antioxidants, l-carnitine (LC) and N-acetyl-cysteine (NAC), in preventing meiotic oocyte damage induced by follicular fluid (FF) from infertile women with mild endometriosis (ME). We performed an experimental study. The FF samples were obtained from 22 infertile women undergoing stimulated cycles for intracytoplasmic sperm injection (11 with ME and 11 without endometriosis). Immature bovine oocytes were submitted to in vitro maturation (IVM) divided into 9 groups: no-FF (No-FF); with FF from control (CFF) or ME (EFF) groups; and with LC (C + LC and E + LC), NAC (C + NAC and E + NAC), or both antioxidants (C + 2Ao and E + 2Ao). After IVM, oocytes were immunostained for visualization of microtubules and chromatin by confocal microscopy. The percentage of meiotically normal metaphase II (MII) oocytes was significantly lower in the EFF group (51.35%) compared to No-FF (86.36%) and CFF (83.52%) groups. The E + NAC (62.22%), E + LC (80.61%), and E + 2Ao (61.40%) groups showed higher percentage of normal MII than EFF group. The E + LC group showed higher percentage of normal MII than E + NAC and E + 2Ao groups and a similar percentage to No-FF and CFF groups. Therefore, FF from infertile women with ME causes meiotic abnormalities in bovine oocytes, and, for the first time, we demonstrated that the use of NAC and LC prevents these damages. Our findings elucidate part of the pathogenic mechanisms involved in infertility associated with ME and open perspectives for further studies investigating whether the use of LC could improve the natural fertility and/or the results of in vitro fertilization of women with ME.

Metritis and endometritis in high yielding dairy cows / Metrite e endometriose em vacas de leite de alto rendimento

Dairy cows have shown a steep increase in milk production, which is unfortunately characterized by a dramatic decline in reproductive performance. In these modern high yielding cows authors worldwide mention a higher number of puerperal problems, such as retained placenta, acute metritis and abnormal vaginal discharge. All of which are known to negatively influence reproductive capacity of these animals. Cows affected by retained placenta and/or acute metritis are furthermore at a significantly higher risk of other typical ‘dairy cow diseases’ such as acetonaemia, displaced abomasum and cystic ovarian disease. It is therefore important that the management of the cows during the transition period should be optimized in order to prevent cows from these disease complexes. Furthermore, during the immediate postpartum period, cows should be looked after properly in order to identify animals that are affected by clinical uterine disease as soon as possible so that treatment should not be delayed. High numbers of cows are furthermore reported to suffer from clinical and subclinical endometritis, both giving rise to significant problems to get in calf. At the moment, there is a lot of debate concerning both the diagnosis as well as the first choice treatment of cows suffering from clinical and subclinical endometritis. Therefore, also for these diseases prevention is far more effective than treatment.

Vacas de leite tem mostrado um aumento marcante na produção de leite, que infelizmente é caracterizado por um declínio dramático no desempenho reprodutor. Com relação a estas vacas de leite modernas de alto rendimento autores ao redor do mundo mencionam diversos problemas de puerpério, como placenta retida, metrite aguda e descarga vaginal anormal. Todos estes conhecidamente afetam a capacidade reprodutora destes animais. Vacas afetadas por placenta retida e/ou metrite aguda estão também em maior risco de outros tipos de “doenças de vacas de leite” como acetonaemia, abomaso deslocado e doença de ovário cístico. É importante, portanto, que o gerenciamento de vacas durante o período de transição deve ser otimizado para prevenir vacas contra estas doenças complexas. Além disto, durante o período pós parto imediato deve haver o cuidado apropriado das vacas para identificar animais afetados por doença uterina clínica assim que possível para não atrasar o tratamento. Um alto número de vacas sofrem de endometriose clínica e subclínica, ambos levando a problemas significativos para reproduzir. No momento há muito debate com relação ao diagnóstico e também ao primeiro tratamento de vacas sofrendo de endometriose clínica e subclínica. Portanto, a prevenção destas doenças também é muito mais eficiente do que o tratamento.

Metritis and endometritis in high yielding dairy cows / Metrite e endometriose em vacas de leite de alto rendimento

Dairy cows have shown a steep increase in milk production, which is unfortunately characterized by a dramatic decline in reproductive performance. In these modern high yielding cows authors worldwide mention a higher number of puerperal problems, such as retained placenta, acute metritis and abnormal vaginal discharge. All of which are known to negatively influence reproductive capacity of these animals. Cows affected by retained placenta and/or acute metritis are furthermore at a significantly higher risk of other typical ‘dairy cow diseases such as acetonaemia, displaced abomasum and cystic ovarian disease. It is therefore important that the management of the cows during the transition period should be optimized in order to prevent cows from these disease complexes. Furthermore, during the immediate postpartum period, cows should be looked after properly in order to identify animals that are affected by clinical uterine disease as soon as possible so that treatment should not be delayed. High numbers of cows are furthermore reported to suffer from clinical and subclinical endometritis, both giving rise to significant problems to get in calf. At the moment, there is a lot of debate concerning both the diagnosis as well as the first choice treatment of cows suffering from clinical and subclinical endometritis. Therefore, also for these diseases prevention is far more effective than treatment.(AU)

Vacas de leite tem mostrado um aumento marcante na produção de leite, que infelizmente é caracterizado por um declínio dramático no desempenho reprodutor. Com relação a estas vacas de leite modernas de alto rendimento autores ao redor do mundo mencionam diversos problemas de puerpério, como placenta retida, metrite aguda e descarga vaginal anormal. Todos estes conhecidamente afetam a capacidade reprodutora destes animais. Vacas afetadas por placenta retida e/ou metrite aguda estão também em maior risco de outros tipos de “doenças de vacas de leite” como acetonaemia, abomaso deslocado e doença de ovário cístico. É importante, portanto, que o gerenciamento de vacas durante o período de transição deve ser otimizado para prevenir vacas contra estas doenças complexas. Além disto, durante o período pós parto imediato deve haver o cuidado apropriado das vacas para identificar animais afetados por doença uterina clínica assim que possível para não atrasar o tratamento. Um alto número de vacas sofrem de endometriose clínica e subclínica, ambos levando a problemas significativos para reproduzir. No momento há muito debate com relação ao diagnóstico e também ao primeiro tratamento de vacas sofrendo de endometriose clínica e subclínica. Portanto, a prevenção destas doenças também é muito mais eficiente do que o tratamento.(AU)

Consenso Centroamericano sobre la fisiopatología, diagnóstico y tratamiento de la endometriosis / American Consensus on the pathophysiology, diagnosis and treatment of endometriosis

La endometriosis se define como la presencia de tejido endometrial fuera de la cavidad uterina y tiene una prevalencia de 6-10% en las mujeres en edad reproductiva. Es una enfermedad inflamatoria crónica de patogénesis compleja. El elemento principal de su fisiopatología es el hecho de ser estrógeno dependiente, por lo que sus manifestaciones clínicas mejoran en la menopausia y durante la gestación y empeoran con la menstruación...

Natural therapies assessment for the treatment of endometriosis.

STUDY QUESTION: Can resveratrol and epigallocatechin-3-gallate (EGCG) inhibit the growth and survival of endometriotic-like lesions in vivo in a BALB/c model of endometriosis, and in vitro in primary cultures of human endometrial epithelial cells (EECs)? SUMMARY ANSWER: Resveratrol and EGCG exerted a potent inhibitory effect on the development of endometriosis in a BALB/c murine model and on the survival of EECs. WHAT IS KNOWN ALREADY: Endometriosis is a common condition associated with infertility and pelvic pain in women of reproductive age. Resveratrol and EGCG are two polyphenols with anticarcinogenic and antioxidant properties that have been proposed as natural therapies to treat endometriosis. STUDY DESIGN, SIZE, DURATION: Fifty-six 2-month-old female BALB/c mice underwent surgical induction of endometriosis. Treatments with resveratrol or EGCG started 15 days post-surgery and continued for 4 weeks. Human biopsies were taken with a metal Novak curette from the posterior uterine wall from 16 patients with untreated endometriosis and 15 controls who underwent diagnostic laparoscopy for infertility. MATERIALS, SETTING, METHODS: After the treatments, animals were sacrificed and lesions were counted, measured, excised and fixed. Immunohistochemistry for proliferating cell nuclear antigen and CD34 was performed for cell proliferation and vascularization assessment in the lesions. The terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end labeling (TUNEL) technique was performed for apoptosis evaluation. Peritoneal fluid was collected to analyze vascular endothelial growth factor levels. Human EECs were purified from proliferative-phase endometrial biopsies and cultured. The effect of both polyphenols on cell proliferation was determined by a colorimetric assay using the CellTiter 96®AQueous One Solution Cell Proliferation Assay kit and on apoptosis by the TUNEL technique, using an In Situ Cell Death Detection Kit with Fluorescein. MAIN RESULTS: In the mouse model, both treatments significantly reduced the mean number (P < 0.05 versus control) and the volume of established lesions (P < 0.05 versus control). Treatments consistently statistically significantly diminished cell proliferation (resveratrol P < 0.01 and EGCG P < 0.05, versus control), reduced vascular density (resveratrol P < 0.01 and EGCG P < 0.001, versus control) and increased apoptosis within the lesions (resveratrol P < 0.01 and EGCG P < 0.05, versus control). Both compounds induced reduction in human EEC proliferation (P < 0.05 versus basal) and increased apoptosis (P < 0.05 versus basal) in primary cultures. LIMITATIONS: In vitro studies were only carried out in epithelial cells from human eutopic endometrium. WIDER IMPLICATIONS OF THE FINDINGS: The present findings are promising and will assist the development of novel natural treatments for endometriosis. STUDY FUNDING: This study was supported by ANPCYT (PICT 6384 BID 1201 OC-AR) and CONICET (PIP 5471), Argentina. None of the authors has any conflict of interest to declare.

Physical therapy and psychological intervention normalize cortisol levels and improve vitality in women with endometriosis.

There is as yet no effective treatment for endometriosis. The objective of this study was to evaluate the effectiveness of submitting women with endometriosis and chronic pelvic pain to a therapeutic protocol involving physical and psychological therapy. Twenty-six female volunteers were submitted to a treatment protocol consisting of 2.5-h sessions, once a week for 10 weeks. We applied a Visual Analogue Scale, the Perceived Stress Questionnaire (PSQ), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Morning, afternoon, and evening levels of cortisol were determined in saliva samples. The PSQ scores were significantly lower after treatment, whereas the scores for the SF-36 vitality and physical functioning domains were significantly higher. Salivary cortisol levels were higher after treatment in the samples collected in the morning, but not in those collected in the afternoon or evening. The post-treatment cortisol levels were similar to those reported for healthy women. There were positive correlations between vitality, role emotional, social functioning, and mental health, and negative correlations to perceived stress. In conclusion, the physical and psychological intervention protocol applied in this study to women suffering of endometriosis was effective in reducing perceived stress, normalizing cortisol levels, increasing vitality and improving physical functioning.

The inhibitory effect of celecoxib and rosiglitazone on experimental endometriosis.

OBJECTIVE: To evaluate the effects of celecoxib and rosiglitazone on the implantation and growth of endometriotic-like lesions in a murine model of endometriosis. DESIGN: Prospective experimental study. SETTING: Animal research and laboratory facility. ANIMAL(S): Two-month-old female BALB/c mice. INTERVENTION(S): Surgically induced endometriosis in female BALB/C mice; 28 days of treatment with celecoxib, rosiglitazone, or their combination; counting, measuring, excising, and fixing lesions. MAIN OUTCOME MEASURE(S): Immunohistochemical examination for proliferating cell nuclear antigen (PCNA), CD31, and CD34 to assess cell proliferation and vascularization, with the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) technique for apoptosis evaluation. RESULT(S): Celecoxib and the combined treatment (celecoxib and rosiglitazone) statistically significantly reduced the mean number of lesions established per mouse, and all treatments diminished the implant volume. In addition, cell proliferation within the implants was statistically significantly reduced, and apoptosis was statistically significantly enhanced by all treatments. Also, we found that all treatments diminished the vascularized area in the lesion. CONCLUSION(S): These results are promising and reveal that celecoxib and rosiglitazone, combined or separately, have a beneficial effect on overall endometriotic growth.

Non-contraceptive health benefits of oral contraceptives.

The use of combined oral contraceptives (COCs) is associated with a reduced risk of developing endometriosis, myomas, and endometrial and ovarian carcinoma. The mechanisms involved are multiple; next to ovulation suppression, a reduction in inflammation in the genital tract is involved. This is accomplished through inhibition of the endometrial expression of enzymes related to the biosynthesis of prostaglandin and oestrogen, particularly cyclooxygenase type II (Cox-2) and aromatase. The blockade of these enzymatic systems by COCs explains the beneficial effects of these compounds in treating the symptoms, and halting the progression of myomas, endometriosis and adenomyosis, all of which are characterized by increased inflammation. Inhibition of aromatase and Cox-2 expression in the endometrium by COCs may explain their efficacy in controlling the pain and excessive uterine bleeding caused by these pathologies. The reduction of inflammation in the endometrium may also be the mechanism behind the lower incidence of endometrial carcinoma in COC users. The blockade of ovulation and ovarian steroidogenesis, on the other hand, may explain the lesser incidence of ovarian cancer and the improvement of acne in users. In conclusion, inflammation appears to play a pivotal role in the development of various benign and malignant gynecological diseases. COCs reduce inflammation in the female genital tract by blocking enzymes such as Cox-2 and aromatase.

Reporte de un caso de perforación intestinal proximal a un área de endometriosis en colon / Reporting of case of intestinal perforation next to area of endometriosis in colon

Se reporta un caso de perforación colónica secundaria a obstrucción intestinal baja producida por un área de endometriosis de Colon. La endometriosis no fue diagnósticada al inicio de su enfermedad actual debido a su presentación como una severa peritonitis fecaloidea, manifestándose como obstrucción intestinal. Se revisa brevemente la literatura Endometriosis

Profilaxis antibiótica en la operación cesárea / Antibiotic prophylaxis in the cesarean surgery

La profilaxis antibiótica ha demostrado ser útil, para disminuir la endometritis puerperal y la infección de la herida operatoria en la operación cesárea. Sin embargo, no hay publicaciones que analicen este beneficio sólo en la cesárea con membranas intactas, ya que el riesgo de infección materna aparece principalmente en la mujer con rotura prematura de membranas (RPM). Objetivo: investigar la eficacia y costos de la asociación de 4 esquemas de antimicrobianos I) penicilina 8 dosis-cloramfenicol 6 dosis, II) cefradina-cloramfenicol 2 dosis de cada uno, III) penicilina-cloramfenicol 2 dosis de cada uno y IV) gentamicina-cloramfenicol 2 dosis de cada uno, para disminuir la tasa de infección materna puerperal (IMP) en la cesárea sin RPM. Diseño del estudio: se admitieron embarazadas de 37 a 42 semanas y cuyo parto fue por cesárea, con y sin trabajo de parto. Se excluyeron las mujeres con cesáreas realizadas en gestaciones con RPM (pretérmino o término) o con infección ovular clínica, aquéllas que usaron antibióticos en los 30 días previos al parto y las con antecedente de alergia a los medicamentos usados. Las pacientes recibieron randomizadamente los 4 diferentes esquemas, administrados profilácticamente en la intervención y en el postoperatorio inmediato. Un V grupo, no recibió antibióticos. Resultados: se enrolaron 270 pacientes. La incidencia de IMP fue 11,1 por ciento (6/54) en el grupo IV y 9,3 por ciento (5/54) en el grupo V. Ninguna de las pacientes que usaron las otras asociaciones hicieron IMP (p <0,01). La endometriosis se presentó en el 7,4 por ciento (4/54) en los grupos IV y V, no ocurriendo casos en los restantes grupos (p <0,05). La infección de la herida operatoria fue 5,6 por ciento (3/54) tanto en el grupo IV como en el grupo V y no hubo casos en las otras series. La IMP se presentó sólo en las mujeres cuya cesárea fue realizada con trabajo de parto 5,5 por ciento (11/200), (p <0,05). Las asociaciones de antimicrobianos más económicas fueron: penicilina g sódica 2 millones 2 dosis, con cloramfenicol 1 g 2 dosis: $ 1022 de costo y gentamicina 80 mg 2 dosis, con cloramfenicol 1 g, 2 dosis: $ 763,9 de costo. Conclusión: el uso profiláctico de las asociaciones penicilina g sódica-cloramfenicol y cefradina-cloramfenicol, ambos esquemas administrados en 2 dosis, previenen la IMP en la cesárea realizada sin RPM. Se recomienda el uso de la primera asociación en las maternidades estatales por su eficacia, bajo costo y seguridad

Terapêutica de reposiçäo hormonal no climatério / Hormonal replacement therapy in climateric

O climatério é um período da vida feminina associado a diversas alteraçöes que apenas em parte podem ser atribuídas à deficiência hormonal. Por outo lado, a expectativa da mulher de que a menopausa representa a passagem para a velhice pode responder por parte da sintomatologia do período. A terapêutica de reposiçäo hormonal (TRH) tem sido indicada no sentido de melhorar a qualidade de vida e prevenir doenças da idade. Contudo, como todo tratamento, näo está isento de riscos. Este estudo se propöe a avaliar os principais riscos e benefícios da estrogenioterapia de reposiçäo, em relaçäo a osso, aparelho cardiovascular, útero e mamas

Manejo de las pacientes con endometriosis a través de cirugía láser CO2 en el centro de fertilidad y esterilidad

Se estudiaron 191 pacientes que consultaron en un período de dos años por dolor pélvico, dismenorrea y /o infertilidad. Se clasificó el estadio de endometriosis y se les dio tratamiento con rayo láser de CO2 por vía translaparoscópica. Se evalúan los resultados del tratamiento de acuerdo a la desaparición de los síntomas o la consecuación de un embarazo