Endometriosis

Question 1

1st line medical treatment

Answer 1

OCP’s and NSAID
Norethindrone up to 15 mg /day -poorly tolerated
IUD

Question 2

2nd line medical treatment

Answer 2

Danazol- deaping of the voice
GnRH agonist- bone loss at 6% annually, decreases memory
- add back norethindrone 5mg daily (improve bone loss)
Depo
Aromatase Inhibitors

Question 3

Why infertility

Answer 3

Distorted Pelvic Anatomy-reduced
efficiency in oocyte pick-up or
transport
Altered peritoneal function-increased
PGs, Interleukins, and macrophages
Abnormal immune function –
antiendometrial antibodies in some
pts.
Impaired implantation-integrins, and
other factors in blastocyst-endometrial
cross-talk

Question 4

Pathogenesis

Answer 4

Estrogen receptor expression increased in
implants
Aromatase increased—resultant increase
in localized estrogen
Estrogen increases COX-2 expression
Cox-2 increases prostaglandin production
Angiogenesis, adhesions, fibrosis,
neuronal infiltration ensue
Variety of immune function alterations may
predispose to endometriosis
Nerve growth factor highly expressed and
nerve fiber density increased in
endometriosis lesions

Question 5

recurrence risk of endometriosis after surgery or discontinued medical

Answer 5

around 40%

Question 6

How many surgeries can someone have for endometriosis and infertility

Answer 6

1 - more decrease ovarian reserve and increase adhesions

Question 7

What is the next step after surgery for infertility

Answer 7

IUI

Question 8

Does surgery always need to be done for endometriosis and infertility

Answer 8

no- just do ART

Question 9

Adverse pregnancy effects due to endometriosis

Answer 9

preeclampsia, preterm birth, c-section

Question 10

endometriosis and ovarian cancer

Answer 10

clear cell
low grade serous
endometrioid