Endometriosis - Treatment

Question 1

appearance of endometriosis in surgery

Answer 1

clear vesicles, red flame lesions, dark pigmented lesions with hemosiderin, white scarring

Question 2

mechanism of pain production in endometriosis

Answer 2

productions of growth factors and cytokines by activated macrophages, active bleeding, irritation of nerves

Question 3

infiltrative endometriosis can be seen on physical exam by

Answer 3

tender nodularity along the cul-de-sac or uterosacral ligament

Question 4

most severe pain is seen when the disease extends >___ below the peritoneal surface

Answer 4

6mm

Question 5

estrogen (increases/decreases) pain threshold

Answer 5

decreases

Question 6

when E2 levels are low in the immediately premenstrual and menstrual phases, pain threshold is _____% lower

Answer 6

30%

Question 7

progesterone has a _________ effect on neuronal activity

Answer 7

dampening

Question 8

endometriotic lesions have a high level of __________ activity which causes local accumulation of estradiol and stimulates growth of the tissue

Answer 8

aromatase

Question 9

pain recurrence after primary and repeat surgery for endometriosis

Answer 9

20-40%

Question 10

pain scores up to 1 year after surgery between excision vs ablation were

Answer 10

no different

Question 11

presacral neurectomy involves interupting

Answer 11

sympathetic innervation to the uterus at the level of the superior hypogastric plexus

Question 12

type of pain that presacral neurectomy may improve

Answer 12

midline pain

Question 13

definitive treatment for women that have completed childbearing

Answer 13

hysterectomy with BSO

Question 14

treatment for menopausal symptoms after hysterectomy with BSO for endometriosis

Answer 14

continuous combined E-P therapy (E alone may exacerbate endometriosis)

Question 15

first line therapy for endometriosis associated pain

Answer 15

NSAIDs

Question 16

proposed mechanism for OCs in treatment of endometriosis

Answer 16

decidualization followed by atrophy of endometrial tissue

Question 17

continuous or cyclic OCs for endometriosis is more effective

Answer 17

continuous

Question 18

OCs in comparison to GnRH-a

Answer 18

less effective

Question 19

LNG-IUS in comparison to GnRH-a

Answer 19

same

Question 20

danazol is a derivative of

Answer 20

17-alpha ethinyltestosterone

Question 21

MOA of danazol in endometriosis

Answer 21

inhibiting LH surge and steroidgenesis and by increasing free T

Question 22

side effects of danazol

Answer 22

hyperandrogenic (hirutism, acne, weight gain, deepening of the voice)

Question 23

MOA of GnRH-a

Answer 23

induction of amenorrhea and endometrial atrophy

Question 24

add back therapy for GnRH-a

Answer 24

NETA (norethindrone acetate)

Question 25

what is the E threshold hypothesis

Answer 25

amount of E necessary to decrease hot flushes and bone loss is less that which would stimulate endometriosis