Endometriosis

Question 1

Endometriosis definition

Answer 1

• Endometriosis is ectopic endometrium: the presence of endometrial tissue outside of the endometrial cavity (uterus)
• Ways of getting endometriosis: menstrual efflux into peritoneal cavity, via lymphatics, coelomic metaplasia, direct extension (adenomyosis)
• Adenomyosis: extension of endometrial tissue into underlying myometrium

Question 2

Sxs associated w/ endometriosis

Answer 2

• Dysmenorrhea (painful menstration)
• Chronic pelvic pain
• Painful intercourse (dyspareunia)
• Infertility
• Abnormal pelvic exam: adnexal mass (endometrioma), uterosacral nodularity (painful nodules on uterosacral ligaments = endometriosis)
• Infertility

Question 3

Risk factors for endometriosis

Answer 3

• Nulliparity
• Family Hx
• Relentless ovulation
• Outflow obstruction (imperforate hymen)
• Hx of pelvic infection
• Infertility associated w/ increased risk

Question 4

Dx of endometriosis

Answer 4

• Requires presence of 2 out of the following 3 outside the endometrium of the uterus:
• Endometrial glands
• Endometrial stroma
• Hemosiderin-laden macrophages

Question 5

Management of endometriosis 1

Answer 5

• Goal of management to relieve pain and halt progression of disease, this is done by interrupting relentless ovulation
• All medical therapies equally effective
• Combination (E+P) contraceptives: improves dysmenorrhea and pain
• Oral/IM/SQ progestins

Question 6

Management of endometriosis 2

Answer 6

• Danocrine (androgen)
• GnRH agonists: results in amenorrhea (Rxs pain too)
• Progestin IUDs
• Aromatase inhibitors (possibly)
• Surgery is indicated for Dx, resection of deep disease and restoring anatomy
• Postop Rx may prolong time to Sx recurrence at least in pts w/ incomplete excision