Endometriosis and Adenomyosis Flashcards
What is endometriosis?
chronic disease of endometrial tissue (glands/stroma) outside of the endometrial cavity
What are the most common sites of endometriosis
Ovary - cystic collection endometrioma
Pelvic peritoneum
Posterior uterus, broad ligament
uterosacral ligament
fallopian tubes
colon, appendix
What is the epidemiology of endometriosis
Almost exclusively in women of reproductive age
10-15% prevalence (underestimated)
chronic pelvic pain and infertility
Risk factors for endometriosis
first degree relatives = 7% risk
autoimmune inflammatory disorders (thought that altered immune system that doesn’t attack ectopic tissue results in endometriosis)
What are the hallmarks of endometriosis
Cyclic pelvic pain starting 1-2 weeks prior to menses, peaking 1-2 days before
-subsides with onset of menses
Other symptoms: dysmenorrhea, dyspareunia, abnormal bleeding, bowel/bladder symptoms, subfertility (can cause dense adhesions)
What are some physical exam findings associated with endometriosis?
Uterosacral nodularity
tenderness on rectovaginal exam
fixed retroverted uterus
tender fixed adnexal mass
What is the therapy for endometriosis?
Empiric medical therapy favored over surgery ONLY in patients not attempting to conceive- suppress/atrophy the endometrial tissue
- Analgesics (NSAIDs)
- Combined OCPs
- Androgenic agents (danazol)
- Progestins
- GnRH agonists (nafrelin acetate, leuprolide)
- -Add back therapy = add low dose progestin to alleviate side effects
- Aromatase inhibitors (anastrozole) = off-label
How is endometriosis diagnosed?
Direct visualization with laparoscopy or laparotomy
What is definitive surgical management for endometriosis
TAH/BSO, lysis of adhesions, removal of any visible endometriosis lesions
-indicated for attempting to conceive, childbearing complete, severe endometriosis refractory to medical management
What is adenomyosis?
Extension of endometrial tissue into the uterine myometrium
Thought to be due to high levels of estrogen stimulating basalis layer of endometrium
How does adenomyosis affect the uterus?
Hypertrophy and hyperplasia adjacent to the ectopic tissue
Typically most extensive in the fundus and posterior uterine wall
Boggy feel of uterus because no pseudocapsule (different from fibroid), diffusely enlarged globular uterus
What are the symptoms of adenomyosis?
Typically asymptomatic
most common symptoms = secondary dysmenorrhea, menorrhagia, both
How to diagnose and treat adenomyosis?
MRI is most accurate, but expensive so pelvic ultrasound is most common Mirena IUD (levonorgetrel) is most effective Hysterectomy is only definitive treatment - requires EMB to rule out other causes minimal symptoms = NSAIDs, combined OCPs, progestins, endometrial ablation
