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General Gynecology > Endometriosis > Flashcards

Endometriosis Flashcards

1
Q

What is the main theory of the etiology of endometriosis?

A

Retrograde Menstruation

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2
Q

What are three main risk factors for endometriosis

A

retrograde flow with outlet obstruction, longer estrogen exposure, family history

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3
Q

What percentage of the general population has endometriosis?

A

5 - 10 %

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4
Q

What percentage of infertile women have endometriosis?

A

40%

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5
Q

What percent of patients with chronic pelvic pain have endometriosis

A

70 - 90%

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6
Q

How much does having a first degree relative with endometriosis increase your risk?

A

7 - 10 fold increase

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7
Q

What are the most common signs on exam of endometriosis?

A

Pelvic tenderness, uterosacral nodularity, pelvic mass

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8
Q

What three factors correlate to the severity of pain a patient feels with endometriosis?

A

Increased density of nerve fibers in peritoneal endometriosis, close proximity of lesion to nerve, depth of infiltration of endometriosis

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9
Q

What percentage of normal appearing peritoneal biopsies will show endometriosis?

A

25%

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10
Q

What is the best way to improve fertility in a patient with endometriosis?

A

Laparoscopic surgical excision

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11
Q

Leuprolide belongs to what class of medications?

A

Gonadotropin releasing hormone agonist

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12
Q

Letrozole belongs to which class of medications?

A

Aromatase inhibitor

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13
Q

What method of OCP administration has best treatment outcomes for endometriosis? Cyclic versus continuous?

A

Continuous

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14
Q

What is the most commonly used progesterone in the treatment of endometriosis?

A

Medroxyprogesterone acetate

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15
Q

How long should you treat a patient with a GnRH agonist WITHOUT addback therapy who has endometriosis?

A

6 months or less

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16
Q

What limits the duration of treatment with GnRH agonists in treating endometriosis?

A

bone loss

17
Q

What is the percent bone loss after 6 months of GnRH agonist use?

A

5 - 15%

18
Q

What are the main side effects associated with the use of GnRH agonists in treating endometriosis?

A

Menopausal symptoms

19
Q

What are the two main goals of progesterone add back therapy when using a GnRH agonist to treat endometriosis?

A

Protect bone health, decrease side effects

20
Q

What is the most common add back therapy to use when treating endometriosis with a GnRH agonist?

A

Norethindrone acetate 5 mg

21
Q

How long is it recommended to use a GnRH agonist WITH add back therapy for the treatment of endometriosis?

A

1 year

22
Q

What should be monitored if treatment with GnRH agonist is used for longer than 6 months-1 year?

A

Bone density

23
Q

What is a risk when using OCPs in a patient with endometriosis and known endometrioma?

A

Rupture of endometrioma

24
Q

What percentage of patients with endometriosis following surgical excision will experience recurrence of symptom within the first year?

A

50%

25
Q

What does the recurrence risk correlate with?

A

Severity of disease

26
Q

What post op treatment may decrease the risk of recurrence?

A

medical treatment with progesterone or GnRH agonist

27
Q

What method of surgical excision is superior in the treatment of endometriosis?

A

None, no method is superior

28
Q

What procedure can be helpful with recurrent, mid-line pelvic pain?

A

presacral neurectomy

29
Q

What are two main side effects of surgical presacral neurectomy?

A

Urinary retention and constipation

30
Q

What percentage of patients will continue to have pain and persistent symptoms following hysterectomy, BSO for endometriosis?

A

15%

31
Q

Ovarian consevation at the time of surgery for endometriosis leads to what rate of recurrence?

A

> 60%

32
Q

Is Estrogen therapy contraindicated in a patient who had a hysterectomy, BSO for Endometriosis?

A

No

General Gynecology (11 decks)

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