Endometriosis

Question 1

benign condition in which endometrial glands and stroma are present outside the uterine cavity

Answer 1

endometriosis

Question 2

what are the triad of symptoms of endometriosis?

Answer 2

dysmenorrhea
dyspareunia (painful sexual intercourse)
dyschezia (pain with defecation)

Question 3

what is common in women with patent fallopian tubes?

Answer 3

retrograde menstruation

Question 4

there is an increased risk of endometriosis in women with what, as indicated by sampson’s theory?

Answer 4

cervical/vaginal atresia

Question 5

there is a decreased risk of endometriosis in women with what?

Answer 5

low estrogen levels

Question 6

most women with endometriosis have what symptom?

Answer 6

chronic pelvic pain

Question 7

the diagnosis of endometriosis is made by which of the following?

Answer 7

tissue diagnosis from direct visualization with laparoscopy or laparotomy

Question 8

what is the classic finding during a laparoscopy?

Answer 8

black powder-burn lesions

Question 9

what does a chocolate cyst indicate?

Answer 9

ovarian endometrioma

Question 10

what 3 things can be found in physical exam?

Answer 10

fixed, retroverted uterus
uterosacral ligament nodules
palpable adnexal mass

Question 11

what medical treatment should be initiated for endometriosis?

Answer 11

follow up in 3-6 months
+/- referral to Gyn Dr for laparoscopy

Question 12

what are 5 medical treatment options for endometriosis?

Answer 12

NSAIDs
OCPs
levonorgestrel-containing IUD
progestins
GnRH agonists

Question 12

medication that must wait to be used until diagnosis is confirmed with surgery

Answer 12

GnRH agonists (DepoLupron)

Question 13

what are the common side effects of GnRH agonists?

Answer 13

“chemical menopause”

hot flashes
vaginal dryness
osteopenia

Question 14

how long should GnRH agonist be used?
what to add if used for longer?

Answer 14

6 months

estrogen/progesterone

Question 15

what guides the surgical treatment to a patient?

Answer 15

future fertility

Question 16

what is the surgical treatment for a patient that desires future fertility?

Answer 16

laparoscopic / open surgery to destroy all endometriotic implants and disease via excision

Question 17

what is the surgical treatment for a patient that does not desire future fertility?

Answer 17

hysterectomy, bilateral salpingo-oophorectomy and removal of endometriotic disease

Question 18

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?

Answer 18

endometriosis

medical management

Question 19

21 yo G1P1 who presents with dysmenorrhea follow up after 3 months on OCPs. she tells you her symptoms are not improved. next step?

Answer 19

referral to gyn

Question 20

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?

Answer 20

“chemical menopause”
hot flashes
vaginal dryness
bone issues

3-6 months

Question 21

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?

Answer 21

add back therapy to prevent osteoporosis and protect heart

continue GnRH

Question 22

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.

Answer 22

offer medical management
if fails, hysterectomy/BSO