Women's Health/ Endometriosis Flashcards
What is endometriosis?
Endometrial glands and stroma implanted in areas outside the endometrial cavity
At what age does endometriosis typically present?
25-35 years
Why is endometriosis rare in premenarchal and postmenopausal females?
Ectopic implants are dependent on hormones
What is the most common site for endometriosis?
Ovaries
Common sites for endometriosis
Ovariess > Cul-de-sac > broad ligament > uterosacral ligament > fallopian tubes > sigmoid/appendix > round ligaments
What are the symptoms of endometriosis?
Three Ds:
- Dysmenorrhea
- Dyspareunia
- Dyschezia
What usually worsens the pain of endometriosis?
Menses (although the pain can occur at any point during the cycle)
Does endometriosis affect fertility?
Yes. Many patients are nulliparous.
What are the signs of endometriosis on physical examination?
- tender/enlarged adnexae
- a retroverted uterus
- tender nodules in the uterosacral ligaments and cul-de-sac
What is the gold standard for diagnosing endometriosis?
Direct visualization of the lesions during laparoscopy
How are endometriosis lesions described?
Raised, blue-colored mulberry spots or brown-colored powder burns
What are chocolate cysts?
Endometriomas formed when endometriosis invades the ovaries
Describe the fluid within chocolate cysts.
Thick, dark blood
What is the treatment for chocolate cysts?
Excision
Does a negative laparoscopy reliably exclude endometriosis?
Yes
Which medicines are used to treat endometriosis?
- Combination oral contraceptive pills (OCPs)/progestin
- androgens (danazol)
- GnRH agonists
What class of medications can provide symptomatic relief in endometriosis?
NSAIDs
How do danazol and GnRH agonists work?
Inhibit pituitary gonadotropin secretion leading to decreased ovarian estrogen production
Are danazol and GnRH agonists as equally effective as OCPs?
Yes.But they have more side effects.
What are side effects of danazol and GnRH agonists?
- hot flashes
- vaginal atrophy
- decreased bone density
When is it appropriate to refer a patient with endometriosis for surgery?
- failed medical management
- severe pain
- desired pregnancy
What is the conservative surgical option for patients who desire pregnancy?
Laparoscopic ablation and excision of implants and adhesions
What is the definitive surgical option?
Hysterectomy with or without salpingoophorectomy
