Endometriosis Flashcards
What is the main theory of the etiology of endometriosis?
Retrograde Menstruation
What are three main risk factors for endometriosis
retrograde flow with outlet obstruction, longer estrogen exposure, family history
What percentage of the general population has endometriosis?
5 - 10 %
What percentage of infertile women have endometriosis?
40%
What percent of patients with chronic pelvic pain have endometriosis
70 - 90%
How much does having a first degree relative with endometriosis increase your risk?
7 - 10 fold increase
What are the most common signs on exam of endometriosis?
Pelvic tenderness, uterosacral nodularity, pelvic mass
What three factors correlate to the severity of pain a patient feels with endometriosis?
Increased density of nerve fibers in peritoneal endometriosis, close proximity of lesion to nerve, depth of infiltration of endometriosis
What percentage of normal appearing peritoneal biopsies will show endometriosis?
25%
What is the best way to improve fertility in a patient with endometriosis?
Laparoscopic surgical excision
Leuprolide belongs to what class of medications?
Gonadotropin releasing hormone agonist
Letrozole belongs to which class of medications?
Aromatase inhibitor
What method of OCP administration has best treatment outcomes for endometriosis? Cyclic versus continuous?
Continuous
What is the most commonly used progesterone in the treatment of endometriosis?
Medroxyprogesterone acetate
How long should you treat a patient with a GnRH agonist WITHOUT addback therapy who has endometriosis?
6 months or less
What limits the duration of treatment with GnRH agonists in treating endometriosis?
bone loss
What is the percent bone loss after 6 months of GnRH agonist use?
5 - 15%
What are the main side effects associated with the use of GnRH agonists in treating endometriosis?
Menopausal symptoms
What are the two main goals of progesterone add back therapy when using a GnRH agonist to treat endometriosis?
Protect bone health, decrease side effects
What is the most common add back therapy to use when treating endometriosis with a GnRH agonist?
Norethindrone acetate 5 mg
How long is it recommended to use a GnRH agonist WITH add back therapy for the treatment of endometriosis?
1 year
What should be monitored if treatment with GnRH agonist is used for longer than 6 months-1 year?
Bone density
What is a risk when using OCPs in a patient with endometriosis and known endometrioma?
Rupture of endometrioma
What percentage of patients with endometriosis following surgical excision will experience recurrence of symptom within the first year?
50%
What does the recurrence risk correlate with?
Severity of disease
What post op treatment may decrease the risk of recurrence?
medical treatment with progesterone or GnRH agonist
What method of surgical excision is superior in the treatment of endometriosis?
None, no method is superior
What procedure can be helpful with recurrent, mid-line pelvic pain?
presacral neurectomy
What are two main side effects of surgical presacral neurectomy?
Urinary retention and constipation
What percentage of patients will continue to have pain and persistent symptoms following hysterectomy, BSO for endometriosis?
15%
Ovarian consevation at the time of surgery for endometriosis leads to what rate of recurrence?
> 60%
Is Estrogen therapy contraindicated in a patient who had a hysterectomy, BSO for Endometriosis?
No
