EXAM #1: ENDOMETRIOSIS Flashcards
What is endometriosis?
Ectopic endometrial growth
What are the three theories of endometriosis?
1) Retrograde menstruation
2) Vascular or lymphatic dissemination
3) Coelomic metaplasia
What is the retrograde menstruation theory of endometriosis?
Direct implantation of ectopic endometrial cells during menstraution
What is the vascular or lymphatic dissemination theory of endometriosis?
Endometrial cells dissemination through lymph or blood vessels
What is the coelomic metaplasia theory of endometriosis?
Multipotential cells in the pelvic cavity become ectopic endometrial cells
What are the risk factors for endometriosis?
1) Early menarche (11 y/o)
2) Shorter cycle interval
3) Prolonged heavy bleeding
What are the protective factors for endometriosis?
1) Multiparity
2) Increased duration of lactation
3) Regular exercise
Where is endometriosis most commonly found?
Ovaries
Aside from the ovaries, where else is endometriosis found?
1) Posterior cul-de-sac (Pouch of Douglas, between rectum and uterus)
2) Round ligament
3) Fallopian tubes
4) Sigmoid colon
What are the classic symptoms of endometriosis?
1) Progressive dysmenorrhea*
2) Deep dyspareunia (thrusting pain)
3) Chronic pelvic pain
4) Sacral back pain
5) Dyschezia (may have blood)
*Suspect in patients that do NOT respond to NSAIDs and oral contraceptives
Are the symptoms of endometriosis related to the extent of endometriosis?
NO
What is an endometrioma?
“Chocolate cyst” found in an ovary
What are the possible methods used to to diagnose endometriosis?
1) Start with imaging (US)
2) CA 125 screening test
3) Trial of Leuprolide (GnRH agonist)
4) Direct visualization*
What are the expected findings with Leuprolide given to a patient with endomitrosis?
Initial flare of sx. followed by improvement
What is expectant management of endometriosis?
DO NOTHING in a patient that:
- Patient w/ limited disease that wants to get pregnant
- Nearing menopause
