05 - 206nyeri Dan Endometriosis-Prinsip Penanganan Berbasis Patofi Siologi Praktis
05 - 206nyeri Dan Endometriosis-Prinsip Penanganan Berbasis Patofi Siologi Praktis
ABSTRAK
Nyeri akibat endometriosis merupakan masalah penting dalam kesehatan reproduksi wanita. Walaupun demikian, belum diketahui secara
pasti jenis nyeri yang patognomonik untuk endometriosis maupun penyebab pastinya. Terdapat beberapa bukti bahwa estrogen, inflamasi,
dan adanya serabut saraf yang dekat dengan lesi endometriosis kemungkinan besar berperan penting terhadap terjadinya nyeri. Dengan
memahami interaksi berbagai faktor ini, dapat diketahui prinsip-prinsip praktis penanganan nyeri pada endometriosis.
Kata kunci: endometriosis, nyeri, estrogen, inflamasi, serabut saraf
ABSTRACT
Pain due to endometriosis is still an important problem in female reproductive health. However the exact mechanism as well as the
pathognomonic pain type in endometriosis is still enigmatic. There were evidences that estrogen, inflammatory process, and the presence of
nerve fibers near endometriotic lesion may contribute to this problem. Understanding the interaction between those factors could improve
pain management in endometriosis. Hartanto Bayuaji Narsoyo. Pain and Endometriosis: Management Principles Based on Practical
Pathophysiology.
Key words: endometriosis, pain, estrogen, inflammation, nerve fibers
PENDAHULUAN
Seberapa besar masalahnya? Endometriosis
merupakan penyakit akibat implantasi jaringan kelenjar endometrium beserta stromanya
di luar kavum uteri.1 Nyeri merupakan
masalah utama pada endometriosis. Sekitar
83% penderita endometriosis melaporkan
adanya nyeri abdominopelvik, dismenore,
dan dispareuni.2,3 Sebaliknya, pada sekitar
33% penderita nyeri panggul kronik, ternyata
ditemukan lesi endometriosis.4 Melihat
kenyataan tersebut, salah satu aspek penting
dalam penatalaksanaan endometriosis adalah
pengendalian nyeri. Walaupun demikian,
masih banyak kontroversi terkait dengan
mekanisme nyeri. Lebih jauh, keadaan
tersebut
menyebabkan
bervariasinya
modalitas penatalaksanaan berdasarkan faktor
kemungkinan penyebab nyeri. Dalam tulisan
ini, akan dibahas prinsip-prinsip penanganan
nyeri akibat endometriosis berbasis pada
pemahaman patofisiologi praktis.
Alamat korespondensi
email: tantobayuaji@gmail.com
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Gambar 1 Perbandingan aktivitas enzim COX-2, aromatase, dan 17B2HSD pada endometrium wanita normal, dengan endometriosis, dan pada jaringan endometrium ektopik; terlihat dampak perbedaan aktivitas ketiga enzim tersebut pada sintesis
prostaglandin dan estradiol10
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