Endometriosis / Adenomyosis

Question 1

Endometriosis:

Answer 1

Endometrial glands / stroma outside of endometrial cavity

Question 2

Endometrioma

Answer 2

Cystic collection in ovary (“chocolate cyst”)

Question 3

Endometriosis diagnosis

Answer 3

Really need surgical confirmation by direct visualization

Question 4

Endometriosis symptoms

Answer 4

Severity of sx doesn’t correlate with amount of endometriosis

Cyclic pelvic pain starting 1-2 wks before menses, peaking 1-2d prior to menses, then subsiding

Also dysmenorhea, dyspareunia, abnl bleeding, infertility

Question 5

Endometriosis, expectant management

Answer 5

Expectant management if minimal sx or trying to conceive

Question 6

Endometriosis, medical management

Answer 6

Suppress / atrophy endometrial tissue
OCPs / progestins to create “pseudopregnancy” (suppress menstruation)
Danzol (androgen derivative; can cause acne/hirsutism/virilization)
Lupron (GnRH agonist; causes menopausal sx) to create “pseudomenopause” (suppress FSH / LH; ovaries don’t create estrogen → less sx).
Can use “add back” therapy with small amt estrogen along with Lupron to minimize sx of menopause, lessen bone loss.

Question 7

Endometriosis, surgical management

Answer 7

Laparoscopy + fulgaration for implants, laparoscopic cystectomy for endometriomas
Definitive = TAH/BSO, lysis of adhesions, fulgaration

Question 8

Adenomyosis

Answer 8

Endometrial tissue (stroma) in to uterine myometrium.
High levels of estrogen → endometrial basalis layer undergoes hyperplasia → invades
Usually in fundus, posterior uterine wall

Question 9

Adenomyoma

Answer 9

Can be an isolated region, but vs fibroid has no pseudocapsule.

Question 10

Signs and symptoms of adenomyosis

Answer 10

Sx: often asx; can have secondary dysmenorrhea, menorrhagia
Signs: diffusely enlarged globular, “boggy” uterus. Can be slightly tender.

Question 11

Diagnosis of adenomyosis

Answer 11

Pelvic U/S often first, then MRI if adenomyosis on ddx (more accurate).
Only definitive dx after hysterectomy!
Need to distinguish - don’t want to go in for myomectomy for fibroids and find adenomyosis (would have to do a TAH!)

Question 12

Treatment of adenomysosis

Answer 12

Since stromal, not glands, not responsive to OCPs / hormones.
Can try to treat with NSAIDs / OCPs / progestins anyway
Hysterectomy is only definitive treatment!