endometriosis and adenomyosis Flashcards
what is endometriosis
chronic disease marked by presence of endometrial tissue (glands and stroma) outside the endometrial cavity
why do endometrial implants outside the uterus cause problems
disrupts normal tissue
forms adhesions and fibrosis
causes severe inflammation
prevalence of endometriosis
10-15%
what is the single most common reason for hospitalization for women of reproductive age
endometriosis
what % of women with chronic pelvic pain//with infertility have endometriosis
20% of those with chronic pelvic pain
30-40% of those with infertility
risk factors for endometriosis
nulliparity
early menarche
prolonged menses
mullerian anomalies
family history in first degree relatives
a relationship observed with some autoimmune inflammatory disorders like lupus, asthma, hypothyroid etc…
what is the clinical hallmark of endometriosis
CYCLIC PELVIC PAIN beginning 1-2 weeks before menses, peaking 1-2 days before menses and subsiding at the onset of menses or shortly after
what are the symptoms of endometriosis
cyclic pelvic pain
dysmenorrhea
dyspareunia
abnormal bleeding
bowel and bladder problems
infertility
when should physical exam for endometriosis ideally be performed
during early menses so the implants are likely largest and most tender so you’re most likely to find them
what might you find on physical exam for endometriosis
you might see the implants
uterosacral nodularity
fixed, retroverted uterus
pain with movement of uterus
tender, fixed adnexal mass if ovary involved
how do you treat endometriosis
if youre thinking endometriosis, empiric medical therapy often preferred over surgical intervention as safe approach
however, only way to actually dx endometriosis is to see it surgically –> can do peritoneal biopsy though not necessary
ddx for endometriosis
other chronic processes resulting in recurrent pelvic pain or an ovarian ass
PID adenomyosis irritable bowel syndrome interstitial cystitis pelvic adhesions functional ovarian cyst ectopic ovarian neoplasms
what are the medical management options for endometriosis
aim to suppress and atrophy uterine tissue
- temporizing measures, not curative
- no role for medical management in patients trying to conceive
use:
NSAIDs
cyclic or continuous estrogen-protestin contraceptives
menstrual suppression with progestin
these induce state of pseudopregnancy by suppressing both ovulation and mesntruation and decidualizing the endometiral implants
who benefits most from typical medical management of endometriosis
those with mild disease who are not trying to conceive
how might patients with mild to severe endometriosis be managed medically
“pseudomenopause” with Danazol (androgen derivative) or GnRH agonists Lupron
both of these suppress FSH and LH–> ovaries do not therefore produce estrogen
existing implants atrophy and new ones do not form
