Endometriosis

Question 1

Edometriosis Presentation

Answer 1

-Chronic Pelvic Pain
-Infertility (30-50)
-Definitive Dx by laparoscopy
Endometrial tissue outside the uterus

Question 2

Endometriosis Etiology

Answer 2

• Retrograde menstrual flow
• Vascular/lymphatic spread
• Immunologic disorder: failure to clear retrograde flow of cells an debris

Question 3

Endometrial tissue outside of the uterus

Issues/Description

Answer 3

-Lesions usually restricted to pelvic cavity
-Lesions generate local inflammation (responding to estrogen and
progesterone)
-Adhesion for between organs: restricts movements

Question 4

How is endometriosis severity classified?

Answer 4

Stage I-IV

How? I don’t know but it isn’t pain, infertility, or therapeutic outcomes….

Question 5

Best results for endometriosis?

Pain and fertility

Answer 5

Surgical excision.

Recurrence after 2-5 years likely (only ovarectormy+/- hysterectomy eliminates the problem)

Question 6

Endometriosis: goal of pharmacological treatment

Answer 6

Reduce pelvic pain

Question 7

Endometriosis pharmacotherapy choices

Answer 7

NSAIDs or CHC equally effective

Question 8

Endometriosis Pharmacotherapy: NSAIDs

• Regimen
• ADRs
• Advantage over CHC

Answer 8

• PRN or continuously (cyclic vs acyclic pain)
• GI upset
• Maintain Fertility

Question 9

Endometriosis Pharmacotherapy: CHCs

Two states

Answer 9

Hypoestrogenic (Cyclic CHCs) or Anovulatory (Continuous - no placebo)

Question 10

Endometriosis Pharmacotherapy: CHCs

-Explain pseudopregnancy

Answer 10

Continuous CHC therapy suppresses menstruation

May result in prolonged infertility

Question 11

Endometriosis Pharmacotherapy: CHCs

Contraindications

Answer 11

Women w/ Hx of Thromboembolism and Women who smoke cigarettes

Question 12

Endometriosis Pharmacotherapy: Progestins
State?
BBW limit
ADRs
Examples

Answer 12

• Anovulatory state with amenorrhea, may result in prolonged infertility
• Therapy limit: 2 years
• Breakthrough bleeding, weight gain, fluid retention, mood changes
• Oral and depot medroxyprogesterone, norethindrone;; Levonorgestrel IUD

Question 13

Endometriosis Pharmacotherapy: GnRH agonists
What did he mention 50 times?
Why?

Answer 13

BONE LOSS

Inhibition of FSH and LH release–> Less estrogen–> decreased BMD

Question 14

Endometriosis Pharmacotherapy:
GnRH agonists
State

Answer 14

anovulatory state by inhibition of FSH and LH release

Question 15

Endometriosis Pharmacotherapy:

GnRH agonists

Answer 15

• Leuprolide (Lupron) IM every 3 mo
• Goserelin (Zoladex) SC Qmo
• Nafarelin (Synarel) IN BID

Question 16

Endometriosis Pharmacotherapy:
Danazol (Danocrine)
MOA

Answer 16

• Steroid w/ weak androgenic effects that suppresses FSH and LH release
• also has some immunosuppressive activity

Question 17

Danazol (Danocrine)

Therapy length

Answer 17

6 mo

Question 18

Danazol (Danocrine) ADRs

Contraindications

Answer 18

• Weigh gain, acne, hot flashes, hirsutism, increased LDL
• Contraindications: Hyperlipidemia or Liver disease
• Teratogenic

Question 19

What was once the “gold standard” for Endometriosis?

Answer 19

Danazol