Endometriosis and Fibroids Flashcards
What primary symptom increases the likelihood of endometriosis?
Pain- chronic pelvic pain, pain with menstruation, pain during intercourse (and dysmenorrhea)
List the 4 etiology theories of endometriosis?
retrograde menstruation
hematogenous/lymphatogenous
coelomic metaplasia (cells from peritoneum and endometrium are derived from a common embryologic precursor
immunological (likely combined with retrograde menstruation)
What are the three different entities/implants included in endometriosis?
endometriotic implant
endometrioma- cysts on the ovary lined by endometerial
rectovaginal adenomyotic nodule
What are the benefits of excision surgery in endometriosis?
reduced recurrance rate of pelvic pain, greater rate of spontaneous conception
there is a modest efficacy of endometriosis ablation in increasing the pregnancy rate
What is the reason for recurrent pain after treatment?
residual disease: microscopic, deep, atypical lesions and immunologic causes
What is the role of medical management in endometriosis?
progesterone in OC suppresses lesion proliferation, reducing pain
patch and hormone ring can also be used to address symptoms (more satisfied with ring therapy)
progesterone IUD suppresses estrogen that is required for lesion development
GnRH agonist can be used (decrease fertility)
injectable progesterone is effective but has side effect of more inter menstrual bleeding (second line)
aromatase inhibitors can also be used (second line)
How do aromatase inhibitors act to improve symptoms in endometriosis?
endometrial tissue has the ability to convert androgen to estrogen via aromatase (supports proliferation of endometrial tissue)
aromatase can prevent conversion to aromatase (used as a last ditch intervention)
What are alternate names of a uterine fibroid?
leiomyoma, myoma : a benign neoplasm comprised mostly of smooth muscle cells
What factors increase your risk for uterine fibroids?
early menarche, OC
Fibroids are responsive to which hormones?
fibroids are both estrogen and progesterone dependent, there is overexertion of estrogen and progesterone receptors within fibroids, size increases in high estrogen states (pregnancy, high dose OC, obesity)
What are the symptoms of uterine fibroids?
pelvic pain heavy menses GI complaints (mass effect) bladder complaints dyspareunia back pain leg pain vascular symptoms infertility
can be asymptomatic
Which type of fibroids effect fibroids to the highest degree?
subserosal- no/little effect
intramural- no/little effect
submucosal- effects fertility
removal of fibroids with intracavitary component seems to benefit infertility
What types of imaging is used in assessment of fibroids?
transvaginal sonography
sonohysterography (water fills cavity)
flexible office hysteroscopy
MRI (definitive)
What are the options for management of fibroids?
hysterectomy (surgical)
uterine artery immobilization (non-operative, pain associated with procedure)
uterine conserving: observation medical (OC, aromatase, GnRH agonists) myomectomy to remove fibroids (surgical) radio frequency ablation MRI guided focused U/S thermal ablation
What indications would suggest a surgical approach?
abnormal uterine bleeding
pelvic pressure
urinary frequency
infertility
