Endometriosis Flashcards
benign condition in which endometrial glands and stroma are present outside the uterine cavity
endometriosis
what are the triad of symptoms of endometriosis?
dysmenorrhea
dyspareunia (painful sexual intercourse)
dyschezia (pain with defecation)
what is common in women with patent fallopian tubes?
retrograde menstruation
there is an increased risk of endometriosis in women with what, as indicated by sampson’s theory?
cervical/vaginal atresia
there is a decreased risk of endometriosis in women with what?
low estrogen levels
most women with endometriosis have what symptom?
chronic pelvic pain
the diagnosis of endometriosis is made by which of the following?
tissue diagnosis from direct visualization with laparoscopy or laparotomy
what is the classic finding during a laparoscopy?
black powder-burn lesions
what does a chocolate cyst indicate?
ovarian endometrioma
what 3 things can be found in physical exam?
fixed, retroverted uterus
uterosacral ligament nodules
palpable adnexal mass
what medical treatment should be initiated for endometriosis?
follow up in 3-6 months
+/- referral to Gyn Dr for laparoscopy
what are 5 medical treatment options for endometriosis?
NSAIDs
OCPs
levonorgestrel-containing IUD
progestins
GnRH agonists
medication that must wait to be used until diagnosis is confirmed with surgery
GnRH agonists (DepoLupron)
what are the common side effects of GnRH agonists?
“chemical menopause”
hot flashes
vaginal dryness
osteopenia
how long should GnRH agonist be used?
what to add if used for longer?
6 months
estrogen/progesterone
what guides the surgical treatment to a patient?
future fertility
what is the surgical treatment for a patient that desires future fertility?
laparoscopic / open surgery to destroy all endometriotic implants and disease via excision
what is the surgical treatment for a patient that does not desire future fertility?
hysterectomy, bilateral salpingo-oophorectomy and removal of endometriotic disease
25 yo patient presents with severe pelvic pain during her periods and is severe enough that she needs to take off from work. Pain with intercourse for the past 6 months and pain with bowel movements. Reports menarche at age 11, periods occur once a month and last 4-5 days and are not heavy. currently sexually active with one partner, in good health and no meds. Wants to have a baby in the next 2 years. vitals are stable. Uterus is mildly tender and non-mobile, and note thickening of uterosacral ligaments. transvaginal US shows no abnormalities. Dx? treatment?
endometriosis
medical management
21 yo G1P1 who presents with dysmenorrhea follow up after 3 months on OCPs. she tells you her symptoms are not improved. next step?
referral to gyn
patient is taken to OR and diagnosis of endometriosis is made. she does not desire pregnancy at this moment. You start her on GnRH agonist. Side effects? duration of treatment?
“chemical menopause”
hot flashes
vaginal dryness
bone issues
3-6 months
patient returns after 6 months on the GnRH agonist and is happy with medication. she desired to continue on the GnRH agonist. how should we counsel?
add back therapy to prevent osteoporosis and protect heart
continue GnRH
48 yo G3P3 comes with a 1 yr history of pelvic pain and was diagnosed with endometriosis at 25 yo and had 3 children after infertility treatment. She had a tubal ligation at age 38. she wants to know recommendations for management options.
offer medical management
if fails, hysterectomy/BSO
