Endometriosis Flashcards
Endometriosis
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
Endometriosis management
varies with extent of symptoms, fertility goals:
- symptom managing medical therapies
- menses reducing/eliminating medical therapies
- surgical ablation, lysis of adhesions.
Adenomyosis
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
why adenomyosis a problem ??
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
adenomyosis Physical exam …
large boggy tender uterus
may have irregular contour
Ultrasound may show myometrial lesions that look similar to fibroids
adenomyosis management
pain control with NSAIDs or narcotics
Hormonal contraceptives
Hysterectomy is the only definitive treatment
FIBROIDS
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.
FiBROIS characteristics
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
Fibroids physical exam findings
fibroids may or may not be palpable
uterus may feel enlarged or irregular-shaped
fibroids are usually non-tender.
Fibroids management
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
uterine leiomyomata (fibroids)
enlarge uterus, usually asymmetric often painless may associate with AUB
adenomyosis
enlarge uterus, usually asymmetric moderate tenderness on palpation increase menses
endometriosis
pelvic pain dysmenorrhea dysparenuria abnormal uterine bleeding
cervical polyps
bright red painless noted after intercourse
nabothian cyst
white firm nodes visible on cervix painless
ovarian cyst
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 !
ovarian cysts management
often include consultation for novices
evaluation for seriousness of cys
simple or complex
size
often expectant management and spontaneous resolution
pain management for acute painsurgery indication for ovarian cyst
–large complex masses
masses that grow larger
elevated CA125
prevent ovarian cyst
combined hormonal contraception –> ovarian suppression
prevent ovulation =prevent ovarian cancer
more ovulation more risk for ovarian cancer
Endometriosis
endometrial tissue leaves the uterus and implant else where in the body (usually the PELVIS)
Adenomyosis
endometrial tissue invades uterine muscle tissue
Noted: thickened wall of uterus which can mistaken for fibroids
who get endometriosis
any menstruating women
high prevalence in women with more periods earlier, shorter cycles heavier longer
