Endo Flashcards
Endometriosis definition
The presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction
Symptoms of endo
Dysmenorrhea CPP Dyspaerunia Infertility Ovulation pain Dyschezia Cyclical bowel or bladder symptoms Chronic fatigue and malaise
Findings consistent with endo
Fixed, retroverted uterus Tender/nodular uterosacral ligaments Visible nodules on the cervix/vagina Palpable rectal nodules Enlarged/tender ovaries
Medical management of endo
NSAIDSs and other simple analgesia COCP Danazol - androgen Gestrinone - progestogen Progestogens GnRH-A Mirena
Stage 1 Endo
Findings restricted to only superficial lesions and possibly a few filmy adhesions
Stage 2 Endo
Some deep lesions are present in the cul-de-sac
Stage 3
As for 1&2 + presence of endometriosis on the ovary and more adhesions
Stage 4
As per 3 but large endometriosis, extensive adhesions
Dense vascular adhesion
Should be divided as is associated with pain relief
May be asymptomatic
Can be caused by endo, previous surgery or infection
Nerve entrapment
Highly localized, sharp, stabbing or aching pain exacerbated by particular movements, and persisting beyond 5 weeks or occurring after a pain-free interval
After one of Anne stein incidense is 3%
Prevalence
1:10
Pathogenesis theories
Retrograde mensturation - flow of endometrial contents in pelvis allows implantation
Metaplasia: transformation of peritoneal tissue/cells into endometrial tissue through hormonal and or immunological factors
Hormones: estrogen driven proliferation of endometrial lesions; resistance to progesterone-mediated control of endometrial proliferation
Oxidative stress and inflammation: recruitment of immune cells and their production of cytokines that promote endometrial growth
Immune dysfunction: prevention of eliminating menstrual debris an promotion of implantation and growth of endometrial lesions
Apoptosis suppression
Genetic
Stem cells
Treatment options (alternative)
Physiotherapy CBT Nutritionist Massage Acupuncture (poor quality evidence)
Invasive therapies
Trigger point injections
Dry needling
Botox
Nerve blocks
How endo affects fertility (PEA OAF)
Autoimmune dysfunction - increased inflammatory cytokines and gngiogenic factors that disrupt both egg and sperm activity
Functional changes- disordered tubal motility and myometrial contractions impair gamete transport
Anatomical distortion - adhesions, mechanical disruption to conception
Ovarian reserve - reduced regardless of ovarian disease present
Endo tx- hormonal tx
Pain - interferes with normal sexual function
