Endometriosis Flashcards
Viable fragments of endometrial tissue is refluxed through the fallopian tube–> implants elsewhere in pelvis
* most widely accepted theory
Retrograde menstruation theory
what must be considered in any woman of reproductive age with CPP or infertility (dysmenorrhea or dyspareunia)
endometriosis
when should a physical examination be done for endometriosis?
just before or during early menses (implants largest, most tender, most active, symptoms most severe)
what are the five most common sites of endometriosis in order?
- ovaries
- cul-de sac
- uterosacral ligament
- broad ligaments
- fallopian tubes
what does definitive diagnosis of endometriosis require?
visualization and histologic confirmation (biopsy)
laparoscopy = visualization
symptoms of endometriosis are dependent on?
location, extent, depth of endometriotic lesions, and adhesions
staging for endometriosis is based on?
location, diameter, depth (superficial vs. deep) and density (quantity) of EM lesions
endometriomas
adhesions
what is typically first line treatment for endometrosis?
medical therapy is typically 1st line
what are the first line medications for endometriosis?
NSAIDs, acetaminophen, antidepressants
OCPs
Progestins
what are second line medications for endometriosis?
GnRH agonists, antagonist
androgenic agent: danazol
antieestrogenic, antiprogesterone, androgenic agent
what is the use of OCPs in endometriosis?
used based on the observation that pregnancy provides pain relief and decreases # and size of endometrial implants
slows growth
decreases possibility of tissue reflux
why the use of progestin in endometriosis?
Decrease estrogens, decrease menstrual flow;
oppose growth promoting effects of estrogen;
decrease estrogen receptors;
convert estradiol to estrone;
decreases cyclic bleeding
what are the most common progestins?
Medroxyprogesterone acetate
-depo provera
-dienogest
-megestrol acetate
-norethindrone acetate
-levonorgestrel- releasing intrauterine system
what is the mechanism of action of GnRH agonists?
inihibit LH/FSH release from pituitiary gland
-prevent ovulation and menstruation
-EST levels similar to menopausal levels with amenorrhea; pseudo-menopause
what is the mechanism of action of GnRH antagonist?
inhibit GnRH receptors in the pituitary–> decrease FSH and LH decreasing estrogen and progesterone
* have to use a barrier method for contraception
what is the mechanism of action of Danazol
its a testosterone derivative
* leads to atrophy of endometrial implants
* must prevent pregnancy, will harm embryo
* cannot use OCPs at same time
which surgery is good for treating mild to moderate cases of endometriosis?
laparascopy
which surgery is good for treating deep, infiltrating lesions?
laparotomy
why is laparoscopy often better?
decreased adhesion formation (overall 35-70%) with laparscopy
how does endometriosis cause infertility
poor ovarian reserve (decreased oocyte production)
decreased oocyte quality
disturbance of ovulation
decreased fertilization
etc.
true or false: infertile patients often have no painful symptoms?
true
early stage EM should be treated how? if the the patient wants children
surgery +supraovulation
advanced disease for a patient who wants kids should be treated how?
Surgery + IVF
ectopic endometrial tissue found within the uterine myometrium. Leads to hyperplasia and hypertrophy
Adenomyosis
what physical findings would you expect in adenomyosis?
high normal or enlarged, globular uterus; may be diffuse or nodular (resembling fibroids; tender uterus
how do you diagnose Adenomyosis?
Enlarged uterus and thickened junctional zone present on MRI
definitive dx- often by pathology/ microscopy (often at hysterectomy)
treatment of adenomyosis?
OCPs in conjuction with NSAIDs and GnRH agonists for symptomatic relief
uterine artery embolization in women who have completed child-bearing
definitive surgery with hysterectomy (preserve ovaries if younger patient)
what does adenomyosis increase the risk of?
Increased risk of preterm birth
increased incidence of preterm labor and premature rupture of membrane
risk of uterine rupture
