Medisinsk behandling av endometriose

Endometriose defineres i korte trekk som endometrievev utenfor livmorhulen. Det er en vanlig, kronisk sykdom som hovedsaklig forårsaker smertesymptomer som dysmenoré, dyspareuni og ikke-menstruelle smerter. Men endometriose kan også redusere fertiliteten og dramatisk redusere en kvinnes livskvalitet. Diagnosen stilles laparaskopisk og synlige lesjoner bør deretter fjernes. Empirisk behandling anbefales også, og prinsippet er å indusere amenoré. Vanlige medisiner i bruk idag omfatter p-piller, forskjellige gestagener og gonadotropin-releasing-hormone(GnRH)-analoger med add-back-terapi. Disse medikamentenes effektivitet er veldokumentert og de har få bivirkninger. Gestagener og p-piller kan brukes over år. Danazol som tidligere var gullstandard i endometriosebehandlingen, brukes nesten ikke lenger grunnet de utstrakte bivirkningene. Gestrinone og mifepreston brukes heller ikke mye i Norge. Mye arbeid legges i å utvikle nye medisiner mot endometriose med mindre bivirkninger. Blant disse finner vi aromatasehemmere, selektive progesteronreseptor-modulatorer (SPRM's), selektive østrogenreseptor-modulatorer (SERM's), angigenesehemmere og tumor-nekrose-faktor-α-hemmere. Kirurgi er fortsatt eneste behandling som potensielt kan helbrede sykdommen, selv om symptomer har en tendens til å vende tilbake over tid. Det er også mulig å kombinere kirurgisk og medisinsk behanling, men det er bare kirurgi som gir økt fertilitet. Hvilken behandling man bør velge for den enkelte pasient må gjøres fra medisinsk erfaring og pasientens preferanser

Unrecognised depression among older people: a cross-sectional study from Norwegian general practice

Background: Depression is common in old age and is associated with disability, increased mortality, and impairment from physical diseases. Aim: To estimate the prevalence of depression among older patients in Norwegian general practice, to evaluate the extent they talk about it during their consultation, whether it was previously known or suspected by their GP, and how frequently patients with depression visit their GP. Design & setting: Cross-sectional study among patients and GPs at 18 primary care clinics in the south of Norway. Method: Patients aged ≥65 years who visited their GP were asked to complete the Patient Health Questionnaire-9 (PHQ-9). The GPs reported what kind of issues the patient presented at the consultation, if a current depression was known, and the consultation frequency. Results: Forty-four (11.4%) of 383 patients reported moderate or severe depressive symptoms (PHQ-9 ≥10). Among the cases with data from both patient and GP (n = 369), 38 patients (10.3%) reported moderately depressive symptoms. Of these, only 12 (31.6%) mentioned psychological problems to their GP during their consultation; 12 (31.6%) with previous depression were neither known to the GP nor suspected of currently having depression; and 67.6% of them visited their GP ≥5 times a year. Conclusion: Older patients tend to speak little of their depression to the GP. Almost one in three older patients with moderate depressive symptoms were unrecognised by their GP. Older patients who frequently visit the GP should be suspected of potentially having mental health problems