Endometrosis Flashcards
What is endometriosis
endometrial tissue outside the uterus.
etiology is not yet fully established; however, retrograde menstruation is one of several factors involved
Risk factors for endometriosis
Retrograde menstruation
- imperforated hymen
Ceolomic/peritoneal metaplasia:
coelomic (peritoneum) contains pluripotent cells that were differentiated into endometrial cells during embryonic development.
Iatrogenic implantation:
Post-surgical scars (episiotomy or laparotomy) are prime locations for implantation of endometrial cells that are spread from delivery or surgical procedures.
Hematogenic and lymphogenic dissemination of endometrial cells
Hereditary
Pathophys of endometriosis
Ectopic endometrial tissue reacts to the hormone cycle in much the same way as the endometrium & proliferates under the influence of estrogen.
Pelvic Endometriotic implants: ovaries, fallopian tubes, cervix or
Extrapelvic endometriotic implants: lung, diaphragm.
Proliferation causes
↑ Production of inflammatory and pain mediators
-Nerve dysfunction
-Altered anatomy (e.g., pelvic adhesions) → infertility!!!
clinical features of endometriosis
1/3 of patients are asymptomatic.
Dysmenorrhea ( painful cramps menstruation)
Dyspareunia(painful sex/ pain after sex)
Dysuria
Dyschezia: painful defecation
Pre- or postmenstrual bleeding
Infertility: d/2 change in the pelvic anatomy by inflammation and adhesions, altering egg quality and impairing movement/ implantation
Common locations of endometriotic implants
Ovaries
Rectouterine pouch
Fallopian tubes
Bladder
Dg of endometriosis
Physical examination
- Rectovaginal tenderness
- Adnexal masses
- parametrial nodules
- fixed cervix
Transvaginal ultrasound (best initial test)
- The uterus is not enlarged as tissue implants ectopically
- CHOCOLATE cysts w/ blood and debris)
- Nodules in bladder or rectovaginal septum
Laparoscopy (confirmatory test)
MRI, colposcopy, cystoscopy, or other interventions are potentially indicated if endometrial cells are suspected.
Severity of findings don’t correlate w/ severity of the condition
What is the main dx for endometriosis
Adenomyosis
Definition: benign disease characterized by the occurrence of endometrial tissue within the uterine Wall
Etiology: The exact etiology is unknown, risk factors have been identified: Endometriosis Uterine fibroids Parity
Clinical features
May be asymptomatic
Dysmenorrhea
Menorrhagia
Chronic pelvic pain, aggravated during menses
Uniformly enlarged uterus, tender on palpation
Diagnostics
Diagnosis is clinical and may be supported by transvaginal ultrasound and MRI findings
-Myometrial wall thickening
-Myometrial cysts
Histology serves to confirm the diagnosis.
Treatment
Conservative: combined oral contraceptives , progestin-only contraception (e.g., IUD, continuous-use contraceptive pill), NSAIDs for pain relief
Surgical: Hysterectomy is the definitive treatment.
Medical therapy for endometriosis
Mild to moderate pelvic pain without complications
-Empirical medical therapy with NSAIDs and continuous hormonal contraceptives (estrogen-progesterone)
Severe symptoms
-GnRH agonists (e.g., buserelin, goserelin) and estrogen-progestin To avoid the side effects of GnRH agonists
What are GnRH agonists
Drugs that agonize the gonadotropin-releasing hormone receptor in the pituitary gland. Constant agonization by the drugs leads to desensitization of the pituitary gland, thereby reducing the secretion of gonadotropins (LH and FSH), and thus lowering the levels of estrogen in female and testosterone in male individuals. Used to treat hormonally sensitive cancer (e.g., prostate CA), to delay puberty in precocious puberty, and to induce a hypoestrogenic state in women with menorrhagia, endometriosis, or uterine fibroids.
Surgical therapy for endometriosis
First-line: laparoscopic excision and ablation of endometrial implants
- If there is a lack of response to medical therapy
- Treat expanding endometriomas and complications (e.g., bowel/bladder obstruction, rupture of endometrioma, infertility)
Second-line: open surgery with hysterectomy with or without bilateral salpingo-oophorectomy
- Treatment-resistant symptoms
- No desire to bear additional children
Complications of endometriosis
Anemia
↑ risk of ectopic pregnancy :Endometriosis in the uterotubal junction inhibits implantation of the egg
Endometriosis → fibrous adhesions → strictures and entrapment of organs
Intestines: constipation (progesterone) or diarrhea( prostaglandins) ; in rare cases, intestinal obstruction, ileus, or intussusception may occur
Ureter: urine retention
Infertility
What is an imperforated hymen
Congenital disorder w/ lack of perforation of hymen during fetal development
Increases retrograde menstrual flow W/ endometrial tissue w/ in menses
often overlooked as flu like symptoms present so endometrios is present contdvebeen avoided
