Endometriosis Flashcards
what are theories of endometriosis etiology?
- retrograde menstruation
- ceolemic metaplasia
- hematologic spread
- lymphatic spread
what are treatments for endometriosis?
surgical
or medical
1st line: NSAIDs, COCs
2nd line: progestins, GnRH agonists, androgens
what are FDA approved progestins for endometriosis?
- DMPA
- PO norethindrone 5 mg daily
considerations with GnRH agnosit therapy
- can be very effective for pain; recommended only for 1 year
- if needed for more than 6 months to a year, need add back therapy
- what are side effects of GnRH agonist therapy - menopausal symptoms, loss of BMD
- does not help infertility
- recurrence rate after discontinuation is high (53-73%)
when to do cystoscopy?
only if suspect bladder involvement
what are surgical options to remove endometriotic implants?
- thermal energy with bipolar
- laser energy/point fulguration
- excisional biopsy
what androgen is often used to treat endometriosis?
Danazol (17 alpha ethinyl testosterone)
- side effects include hirsuitism, acne, myalgias
what can fertility sparing surgery help with?
- can help with symptoms, although risk of recurrence is at least 33% in 3 years
- can help with fertility, although magnitude unclear. probably more for early stage disease
what are the risks of recurrence of symptoms and repeat surgery after hyst/BS vs hyst/BSO?
Hyst/BS:
- risk of recurrence: 62%
- risk of additional surgeries: 31%
Hyst/BSO
- 10-15% recurrence, esp with estrogen tx
- 4% repeat surgery
RR of recurrent pain with ovarian conservation: 6.1
RR of additional surgery with ovarian conservation: 8.1
risk of disease progression in asx patients?
~40% disease progression
20-30% stable
20-30% resolve
how should endometriomas be managed?
- can improve fertility; thus if pt desires fertility would remove
- cystectomy > drainage
- some recommend removal > 3 cm
