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443-SRH and MSK > Endometriosis > Flashcards

Endometriosis Flashcards

1
Q

what is endometriosis

A

A condition where endometrial tissue grows outside endometrium

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2
Q

what is the most common type of endometriosis

A

pelvic endometriosis

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3
Q

what is a less common type of endo

A

extrapelvic endo

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4
Q

what is the genetic risk with endo

A

first degree relative on mother’s side = 7-10x risk

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5
Q

what is the suspected hormonal pathogenesis of endo

A

may have ↓ response to progesterone on endometrium from ↓ receptors on endometrial tissue/ implants = inability to cause apoptosis of endometrial tissues

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6
Q

what is the suspected mechnical pathogenesis of endo

A

cervical stenosis = retrograde menstruation

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7
Q

what is the suspected immunological pathogenesis of endo

A

△ T+B cell function, lvl of cytokines and GF in endometrial tissue
Immunologic abnormality prevents clearance of endometrial tissue fragments from exiting peritoneum OR
Immune system stimulation caused by presence of endometrial tissue in peritoneum = increased inflammation

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8
Q

what is the mullerian embryonic theory of endo

A

during embryonic development, remnants present in other parts of the body which can form endometrial tissue

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9
Q

what is the lymphatic and vascular metastasis that can cause endo

A

extrapelvic- transport of lesions through vascular/ lymph system

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10
Q

what is the coelomic metaplasia theory of endo

A

metaplasia of cells in mesothelial lining of the organs = transforms normal peritoneal cells into endometrium like

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11
Q

what is the endometrial stem cell implantation that can lead to endo

A

endo cells originate from stem cells

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12
Q

sx of endo

A

Pain: pelvic, abdominal, lower back
Dysmenorrhea + pain with ovulation
Spotting or bleeding b/w periods
GI sx (more if GIT involved): painful BM, diarrhea during period, abd bloating
Painful urination or increased urgency (if bladder involved
Heavy periods

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13
Q

endo symptoms are more linked to
1. severity of implants
2. placement of implants

A

2

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14
Q

endo sx often resolve with

A

menopause

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15
Q

an endo diagnosis can be based on

A

S/S
Transvaginal ultrasound (for deep implants or abnormal sites)
Laparoscopy (+confirmed with biopsy) or CT or MRI
Sometimes CA-125 but is not specific for endo and more for ovarian cancers (may be increased if endo on ovaries)

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16
Q

T or F: staging matches well with severity of sx

A

F

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17
Q

pharm classes used for endo

A

NSAIDs
CHC
progestins
LNG-IUS
danazol
GnRH agonists and antagonists

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18
Q

what do progestins do in endo

A

atrophy of endometrial tissues

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19
Q

what is dienogest used for in endo

A

to manage pelvic pain + shown to be as effective as leuprolide

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20
Q

what is danazol

A

Androgen derived from 17-a ethinyl testosterone = androgenic effects

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21
Q

danazol MOA

A

Suppresses pituitary ovarian axis = ↓FSH and LH = directly inhibits ovarian steroidogenesis = ↓ E = atrophy of endometrial implants

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22
Q

danazol AEs

A

acne, weight gain, fluid retention, hirsutism, deepening of voice, ↑LFT, ↓HDL, ↑LDL
Most reversible, except for lowering voice

23
Q

what is contraindicated for danazol

A

severe liver disease, hyperlipidemia

24
Q

what to monitor for if on danazol

A

LFTs if >6mths

25
Q

GnRH agonists MOA

A

Continuous GnrH release (vs normal pulsatile) = gonadotrophin desensitization + ↓ receptors = ↓FSH, LH = ↓ estrogen = medical menopause

26
Q

what is a counselling point for GnRH

A

will get worse before it gets better

27
Q

response rate of GnRH for endo

A

85-100% of pts in 4-8wks

28
Q

how long are GnRH recommended to be used for

A

<6mhs due to BMD loss

29
Q

Buserelin acetate is a

A

nasal spray or SQ inj

30
Q

Goserelin acetate is a

A

depot SQ

31
Q

Leuprolide acetate is a

A

depot IM

32
Q

Nafarelin acetate is a

A

nasal spray

33
Q

Triptorelin pamoate is a

A

depot IM

34
Q

AEs of GnRH

A

menopausal sx (medical oopherectomy)- vasomotor sx (hot flashes, night sweats), vaginal dryness, headache, ↓ libido, insomnia, ↓ in BMD (1% per mth of use)
Depot has greater menopausal sx + bone loss comp short acting

35
Q

what form of GnRH has greater menopausal sx and bone loss

A

depot

36
Q

how to lower GnRH AEs

A

add back E and P

37
Q

what is elagolis

A

direct antagonist of GnRH = decreased FSH/LY = lowered E

38
Q

elagolis AEs

A

vasomotor sx,. Vaginal dryness, headache, ↓ libido, insomnia, ↓ BMD (reversible with d/c), ↑ lipids

39
Q

add back therapy is required for elagolis doses above

A

200mg bid

40
Q

are aromatase inhibitors used in endo

A

only when not responding to other therapies + still in investigation

41
Q

what is conservative surgery for endo

A

laparoscopy

42
Q

what surgery can be done for endo in women who still want children

A

laparoscope

43
Q

recurrance rate of endo from laparoscope

A

20-40%/yr

44
Q

what surgery can be used for chronic pelvic pain

A

LUNA: laparoscopic uterine nerve ablation
Presacral neurectomy- in conjunction with conservative surgery

45
Q

what is radical surgery for endo

A

Hysterectomy +/- removal of both ovaries

46
Q

T or F: there can still be recurrence of endo even after a hysterectomy

A

T- 3-5% of pts

47
Q

how long should each therapy for endo be trialed before moving on

A

2-3mths

48
Q

what is first line for endo

A

CHC + NSAIDs or progestins

49
Q

what is second line for endo

A

LNG-IUS, GnRH agonist + add back HT or GnRH antagonist

50
Q

what is third line for endo

A

laparoscopy

51
Q

what is 4th line for endo

A

surgical tx

52
Q

what are some alt options for endo

A

Neuromodulators for chronic pain :TCAs, SNRIs, gabapentinoids (gabapentin, pregabalin)
Muscle relaxants
Complementary therapies: lifestyle (exercise, diet, sleep, mindfulness, CBT), pelvic floor physiotherapy

53
Q

what 3 meds have the best evidence for endo

A

progestins
danazol
GnRH agonists

54
Q

which agents for endo treatment most commonly cause BTB

A

progestin and danazol

443-SRH and MSK (24 decks)

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