title: The effect of the hormonal milieu of pregnancy on deep infiltrating endometriosis: serial ultrasound assessment of changes in size and pattern of deep endometriotic lesions.
abstract: BACKGROUND
  Deep infiltrating endometriosis (DIE) is associated with severe painful symptoms and represents a complex management challenge.
  
  
  OBJECTIVE
  To analyse the effect of pregnancy on deep infiltrating lesions and related symptomatology.
  
  
  METHODS
  As part of a longitudinal study performed over the past 3 years to determine the efficacy of hormonal treatment in treating women with DIE, we identified three cases of advanced pelvic endometriosis, all with DIE (deep recto-vaginal and recto-sigmoid involvement) where patients achieved spontaneous pregnancies. They were followed up by transvaginal ultrasound (TV-US). The main outcome measures were analysis of the size and echographic pattern of deep infiltrating lesions of endometriosis and evaluation of clinical symptoms during pregnancy.
  
  
  RESULTS
  We observed modifications in lesion size and pattern. In the two patients observed in the third trimester, the lesions were more homogeneous with less evident limits of nodules and band-like echoes, less fibrotic-like. All patients showed complete resolution of symptoms during pregnancy.
  
  
  CONCLUSIONS
  The hormonal environment produced by pregnancy might determine significant modifications of endometriotic lesions and reduce painful symptoms. As surgery for DIE is difficult, complex and can lead to major complications, the achievement of a pregnancy-specific hormonal state, through pregnancy or hormonal treatment, may be a valid option in selected cases.
authors.affiliation: Department of Science for the Woman and Child's Health, University of Florence, via Ippolito Nievo, 2, 50100 Florence, Italy. cocciame@tin.it
authors.forename: Maria Elisabetta
authors.initials: ME
authors.lastname: Coccia
authors.forename: Francesca
authors.initials: F
authors.lastname: Rizzello
authors.forename: Antonio
authors.initials: A
authors.lastname: Palagiano
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Scarselli
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D014463:Ultrasonography