Endometriosis

Question 1

What is Endometriosis?

Answer 1

• The growing of Endometrium cells in other abnormal locations or area.

Question 2

Symptoms?

Answer 2

• Cyclic pain
• Dyspareunia
• Dysmenorrhea, for > a week
• Dysuria
• Dyschezia
• Abdominal bleeding
• Pelvic pain

Question 3

Causes ?

Answer 3

• Genetics
• Immune factors
• Early age menarch
• Delay child bearing
• Retrograde menstruation
• Long menstrual cycle > 7days
• Short menstrual cycle
• Iron deficiency and hypoxia

Question 4

Physical examination?

Answer 4

• Visual inspection
• Speculum examination
• Bimanual examination

Question 5

Workup?

Answer 5

• Lab testing:
  • CA125 test
  • CBC
  • Urin HCG
  • Urin analysis
  • Urine culture
  • Vaginal and cervical culture
• Imaging :
  • Transvaginal sonography (US)
  • CT, MRI (in some cases)
• Diagnostic laparoscopy, is definitive means of diagnosing endometriosis

Question 6

Differential diagnosis?

Answer 6

• Ectopic pregnancy
• Primary dysmenorrhea
• Ovarian cyste
• Ovarian cancer
• Chronic UTI
• Pelvic adhesions

Question 7

Medical management goal?

Answer 7

• Control pain
• Reduce lesions
• Facilite pregnancy
• Tx will depend on various factors :
• Specific symptoms
• Severity
• Location
• Desire for future fertility

Question 8

Medical treatment?

Answer 8

** Medical agents :
• First line treatment:
- NSAID
- COC (combined oral contraceptive)
- Progestin
• Second line treatment:
- Androgens
- GnRh agonists
- Aromatase inhibitors

Question 9

Surgical management?

Answer 9

• Laparoscopy surgery to excise or ablate the endometrial tissue and remove adhesions (adhesiolysis)
• Hysterectomy

Question 10

Indicating for surgery?

Answer 10

• Adnexal mass
• Infertility
• Fail to respond to medical therapy