Endometriosis Flashcards
Why does endometriosis cause pain?
Bleeding –> inflammation + fibrosis –> pain
Prevalence of endometriosis
Age
Prevalence of endometriosis: 10% of all women, 30% of subfertile women, 60% of women w/ pelvic pain.
Occurs in young women (avg age 28).
Familial predisposition.
4 etiology theories of endometriosis
Retrograde menstruation
Hematogenous
Coelomic metaplasia
Immunological
Endometrioma
Cause
US appearance
- Endometrioma = ovarian cyst filled w/ endometriotic tissue.
- Metaplasia of the surface of the ovary may lead to endometriomas
- US shows hypoechoic cyst w/ ground-glass appearance
2 main sxs of endometriosis
Other sxs
- Pain and infertility
- Pain w/ period and sex are most common.
- Others: dysuria, dyschezia (constipation), infertility, GI (mainly involves rectum and sigmoid; sxs include bloating, pain, change in bowel habits, or anorexia)
Physical exam findings of endometriosis (5)
Cul-de-sac tenderness / obliteration, nodularity of uterosacral ligaments, fixed retroverted uterus, ovarian enlargement, lateral cervical displacement
Natural history of endometriosis
1/3 improve, 1/3 stay the same, 1/3 get worse
Surgical treatment for endometriosis
2 kinds
Efficacy
- Surgery may be conservative (just endometriosis) or extensive (hysterectomy + bilateral salpingo-oopherectomy).
- Pain is improved in 80% of pxs. Slight increase in fertility
- Pxs w/ oopherectomy may require estrogen replacement therapy, which does not increase risk of recurrence.
5 medical therapies for endometriosis
- OCPs – estrogen induces progesterone receptor. Progestin is the main component that then treats the sxs and reduces pain.
- GnRH agonists – inhibit LH / FSH secretion → low estrogen. Side effects are menopausal-like
- Progesterone-containing IUDs
- Aromatase inhibitors (require additional progestin to be effective)
- IVF is a last resort
How common are fibroids?
80% of women have them, but most are asymptomatic
Etiology of fibroids
Fibroids are both estrogen and progesterone-dependent. Increased receptors in fibroids. Fibroids are larger during high estrogen states (pregnancy, high dose OCPs, obesity)
Sxs of fibroids (9)
- Pain (pelvic, back, leg), menstrual irregularities, menorrhagia, anemia, GI, bladder, dyspareunia, vascular sxs, infertility
- May cause bleeding if inside the uterus
- Outside the uterus: may cause pressure and press on bowel, cause sciatica, or back pain.
Things that increase risk for fibroids (6)
- Early menarche, OCPs before 16 y/o, high BMI, genes, AA
* High estrogen / progesterone, and number of periods (more w/ age) are risk factors.
Things that decrease risk for fibroids (5)
Increased parity, progesterone-only injectable contraceptives, fruit, veggies, dairy
Treating fibroids
Gold standard
Uterine conserving methods (7)
- Hysterectomy – gold standard due to lowest risk of recurrence.
- Uterine conserving methods
- Observation
- Hysteroscopic / laparoscopic resection (robot-assisted)
- Medical – see next card
- Myomectomy
- Uterine artery embolism
- Radiofrequency ablation
- MRI-guided US thermal ablation
Medical treatments for fibroids (5)
Trenexamic acid, progesterone-IUD, OCPs, aromatase inhibitors, GnRH agonists (best medical tx; but bad side effects so only reserved for presurgical treatment). Overall, meds don’t work as well as surgery.
Indications for surgical removal of fibroids (4)
Abnormal uterine bleeding, pelvic pressure, urinary frequency, infertility.
Do NOT treat if asymptomatic.
Malignant form of a fibroid
Leiomyosarcoma
