Endometriosis Flashcards
Mechanism of Pain
1) Focal bleeding of endometriotic implants
2) inflammatory cytokines in peritoneal cavity
3) irritation or infiltration of pelvic nerves
4) persistent neural input from endomet lesions lead to central sensitization of nociceptive system which leads to somatic hyperalgesia
Mechanism of Infertility
1) distorted anatomy inhibiting ovum capture and release
2) chronic inflammation –> altered folliculogenesis, fertilization and implantation
3) poor oocyte quality
4) altered endometrial receptivity
5) aggressive surgery –> makes ubos your follicles
theories of endometriosis
1) retrograde menstruation (mullerian)
2) coelomic epithelium (prepubertal, men, lungs)
3) lymphatic/vascular dissemination
4) iatrogenic/direct transplantation (CS scar)
5) immune
6) genetic
molecular mechanisms of endometriosis
1) inc estrogen production
2) inc PGL synthesis
3) dec progesterone action
ENZIAN
for DIE
I - <1
II - 1-3
III - >3
F (uterine/extragenital)
FA adeno
FB bladder
FU ureter
A - RV/vagina
B- sidewalls, cardinals, USL
C - rectum
RASRM
does not correlate with symptoms and chance of conception
STAGE I - 1-5 - peritoneal disease, no adhesions
STAGE II - 6-15 - <5 cm
STAGE III -16-40 - OMA, (+) adhesions
STAGE IV - >40 - no cul de sac
EFI
predicts cumulative pregnancy rates over 3 years after surgery which range from 10% (EFI 0-3) to high 75% (9-10)
Goals of surgical tx
restore normal anatomy
remove all visible lesions
prevent adhesions
estrogen threshold hypothesis
30-300pg/ml –> level of E2 for EM growth in premenopausal women
<20pg/ml - HRT
E2 level needed for prevention of VMS is lower than that needed to stimulate growth of endomet
medical tx
1) OCPs (continuous)
2) progestins
3) GnRH agonists
4) GnRH antagonists
5) Danazol
risk of POI with bilateral cystectomy
2.5%
