Endometriosis

Question 1

Define endometriosis

Answer 1

Presence of functioning endometrial glands and stroma outside the usual location of the uterine cavity

Question 2

What are the most common sites of endometriosis

Answer 2

ovary
broad ligament
uterosacral ligaments
rectosigmoid colon
bladder

Question 3

Describe the transplantation theory of endometriosis

Answer 3

retrograde menstruation seeds the abdominal cavity and causes endometriosis

Question 4

Describe the hematogenous/ lymphatogenous theory of endometriosis

Answer 4

blood/ lymphatic vessels spread endometrial tissue

supported by cases of distant endometriosis (ex lacrimal gland)

Question 5

Describe the coelomic metaplasia theory of endometriosis

Answer 5

peritoneal mesothelium from which the Müllerian duct is derived undergoes metaplastic transformation into endometrial tissue

Question 6

Describe the immunologic theory of endometriosis

Answer 6

altered immune responses cause problems clearing endometrial cells from different locations

Question 7

Describe the “combination” theory of endometriosis

Answer 7

 peritoneal implants = retrograde effluent
 endometriomas = coelomic metaplasia
 rectovaginal = Müllerian remnants

Question 8

What are the clinical features of endometriosis?

Answer 8

• pain including dysmenorrhea, dyspareunia, chronic pelvic pain
• infertility
• menstrual irregularities
• GI complaints- bloating, cramping, hematochezia, anorexia

Question 9

Contrast conservative, medical, and surgical therapy for endometriosis

Answer 9

• expectant management: long term pregnancy rate 50-90%, disease can regress
• medical: progestins or OCPs to control pain, GnRH agonists to suppress LH/ FSH production, aromatase inhibitors
• surgical: conservative approach would be drainage of cysts etc but leave reproductive organs in place; definitive surgery is TAH/ BSO

Question 10

What approaches can be used to improve pregnancy rates in women with endometriosis?

Answer 10

ovulation induction with clomiphene, gonadotropins
intrauterine insemination
IVF

Question 11

Describe the epidemiology of uterine fibroids

Answer 11

very common

higher rates in African American women

Question 12

Less than 1% of fibroids convert to ________

Answer 12

leiomyosarcomas

Question 13

Fibroids grow during _____ and regress during ______

Answer 13

pregnancy, menopause

Question 14

List the three classifications of uterine fibroids

Answer 14

submucosal
intramural
subserosal

Question 15

What are symptoms of uterine fibroids?

Answer 15

asymptomatic
pelvic pain
menstrual irregularities
bladder issues
GI issues
back/ leg pain
infertility

Question 16

What is the preferred treatment of fibroids in patients for whom pregnancy is desired?

Answer 16

hysteroscopic or laparoscopic resection

Question 17

What are treatment options of fibroids when fertility is not desired?

Answer 17

uterine artery embolization

hysterectomy