Endometriosis

Question 1

Endometriosis

Answer 1

size & number of endometriosis implants not always correlated with severity of the symptoms

H&PE can indicate likely endometriosis but LAPAROSCOPY is gold standard for diagnosis

Question 2

Endometriosis management

Answer 2

varies with extent of symptoms, fertility goals:

• • symptom managing medical therapies
• • menses reducing/eliminating medical therapies
• • surgical ablation, lysis of adhesions.

Question 3

Adenomyosis

Answer 3

most common in women age 35-50
sometimes asymptomatic –so often undiagnosed
difficult to know true incidence–final dx only with microscopic evaluation after hysterectomy

Question 4

why adenomyosis a problem ??

Answer 4

sometimes it isn’t –it may be asymptomatic
may have pain– dysmenorrhea, non-cyclic uterine cramping, deep dyspareunia –perhaps from irritation of uterine muscle.
bleeding –MENORRHAGIA often attributed to perimenopause

Question 5

adenomyosis Physical exam …

Answer 5

large boggy tender uterus
may have irregular contour
Ultrasound may show myometrial lesions that look similar to fibroids

Question 6

adenomyosis management

Answer 6

pain control with NSAIDs or narcotics
Hormonal contraceptives
Hysterectomy is the only definitive treatment

Question 7

FIBROIDS

Answer 7

aka myomas or leiomyomas
benign uterine smooth muscle tumors/growths
vary in size from teeny -tiny to HUGE
can be single or multiple
Can vary in which uterine layer is involved.

Question 8

FiBROIS characteristics

Answer 8

common especially as women get older & in black women
very responsive to hormones particular estrogen
Many fibroids are asymptomatic but women with fibroids may present with
–>menorrhagia
–>dysmenorrhea
–>pelvic pressure
–>increased abdominal size

Question 9

Fibroids physical exam findings

Answer 9

fibroids may or may not be palpable
uterus may feel enlarged or irregular-shaped
fibroids are usually non-tender.

Question 10

Fibroids management

Answer 10

often expentant management and aimed at symptoms relief
Depends on whether fibroids are symptomatic/bothersome fertility goals and proximately to menopause
other possible treatment: medical therapy with combined hormone contraceptives, anti-estrogen therapies like leuprolide, LNG-IUS, surgeries like myomectomy and hysterectomy, and uterine artery embolization

Question 11

uterine leiomyomata (fibroids)

Answer 11

enlarge uterus, usually asymmetric often painless may associate with AUB

Question 12

adenomyosis

Answer 12

enlarge uterus, usually asymmetric moderate tenderness on palpation increase menses

Question 13

endometriosis

Answer 13

pelvic pain dysmenorrhea dysparenuria abnormal uterine bleeding

Question 14

cervical polyps

Answer 14

bright red painless noted after intercourse

Question 15

nabothian cyst

Answer 15

white firm nodes visible on cervix painless

Question 16

ovarian cyst

Answer 16

ovarian--> follicle (cyst (>2cm) 
**can be asymptomatic or may cause pain 
often unilateral adnexal pain 
gradual or sudden 
mild or severe 
be mindful of the patient's emotional reaction !

Question 17

ovarian cysts management

Answer 17

often include consultation for novices 
evaluation for seriousness of cys 
     simple or complex 
     size 
often expectant management and spontaneous resolution 
pain management for acute pain

Question 18

surgery indication for ovarian cyst

Answer 18

–large complex masses
masses that grow larger
elevated CA125

Question 19

prevent ovarian cyst

Answer 19

combined hormonal contraception –> ovarian suppression
prevent ovulation =prevent ovarian cancer
more ovulation more risk for ovarian cancer

Question 20

Endometriosis

Answer 20

endometrial tissue leaves the uterus and implant else where in the body (usually the PELVIS)

Question 21

Adenomyosis

Answer 21

endometrial tissue invades uterine muscle tissue

Noted: thickened wall of uterus which can mistaken for fibroids

Question 22

who get endometriosis

Answer 22

any menstruating women

high prevalence in women with more periods earlier, shorter cycles heavier longer