endometriosus

Question 1

prevalence

Answer 1

5-15% of women

Question 2

typical age of onset

Answer 2

30yrs

Question 3

Sampson’s theory

Answer 3

retrograde menstruation 
(menses via tubes into intraabdominal area)

Question 4

Meyer’s theory

Answer 4

mullerian (Coelomic) metaplasia theory

Question 5

halban’s theory

Answer 5

lymphatic spread

substances released / shed from endometrium induce formation of endometriosus

Question 6

most common site of occurrence

Answer 6

ovary

Question 7

sx triad

Answer 7

dysmenorrhea
dyspareunia
dyschezia

Question 8

sine qua non

Answer 8

sharp, firm, exquisitely tender barb (barbed wire) in uterosacral ligaments

Question 9

U/S findings

Answer 9

adnexal mass of complex echogenicity internal echoes consistent with blood

Question 10

1st line tx

Answer 10

NSAID
OCP
Progestines

Question 11

2nd line tx

Answer 11

1. mirena IUD
2. Lupron GnRH agonist
3. high dose progestin
4. danazol: suppresses LH and FSH

Question 12

in all women minimize ___ and suppress___ lowers risk for endometriosus

Answer 12

min. menstrual flow

suppress ovarian cycling

Question 13

endometriomas over __ should be removed surgically

Answer 13

3cm

Question 14

most definitive tx

Answer 14

hysterectomy

Question 15

why does GnRH agonist help tx this?

Answer 15

This provides a constant GnRH secretion not a pulsatile fashion which leads to LH and FSH

so it helps relief pain.. but have hot flahs and vaginal dryness and bone loss

Question 16

lupron

Answer 16

GnRH agonist

Question 17

max duration on Lupron?

Answer 17

6mo

concerned about bone health

Question 18

previous gold standard tx

Answer 18

danazol