A 35 yr old female P1 L1 A2 had previous H/o lower abdominal pain , vomiting 1 yr back..CA 125 was 170.80..other blood investigation were within normal limits.Ct abd and pelvis showed Right hydrosalpinx and left complex ovarian lesion.She was operated for laproscopic left ovarian cystectomy with right salphingectomy on 3/3/17.HPE report was simple benign serous cyst and tubal endometriosis..Now she has complaints of lower abdominal pain ..recently usg was taken ..and reports were attached..pls suggest next line of management

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Rpt diagnostic lap and biopsy

Endometriosis... put her on dienogest for 90days

Followed by dienogest 2 mg od for 6 months for pseudonenopause to avoid recurrence.

Recurrent endometriotic cysts. May be asso. PID. Give her a course of broadspectrum antibiotic for 2 weeks. If pain persists, redo diag. Laparoscopy , adhesiolysis and cyst drainage and excision

Continuous cos for 4 maths with 4 days break/ tab dienogest 2mg of for 3 maths

Thank u mam
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Give her dienogest 2mg daily for atleast 6 months. Do TVS at 3 month & at 6 month and reassess the disease regression.

Thank u sir
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inj leuprolide 3.75 i/m monthly for 4 / 6 month. for pain NSAID

Thank u mam
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Tab. Dronis 30 continuous without break for 3 months

Thank u sir
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If endometriosis is confirmed , put the pt on dienogest 2mg OD for 3 months .... Endometriosis is associated with infertility and multiple endocrinopathies..... Evaluate thoroughly

Thank u mam
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Endometriosis with PID. Can try OC pills

Thank u mam.. whether any repeat surgical intervention needed mam?
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