Women's Health/ Endometriosis

Question 1

What is endometriosis?

Answer 1

Endometrial glands and stroma implanted in areas outside the endometrial cavity

Question 2

At what age does endometriosis typically present?

Answer 2

25-35 years

Question 3

Why is endometriosis rare in premenarchal and postmenopausal females?

Answer 3

Ectopic implants are dependent on hormones

Question 4

What is the most common site for endometriosis?

Answer 4

Ovaries

Question 5

Common sites for endometriosis

Answer 5

Ovariess > Cul-de-sac > broad ligament > uterosacral ligament > fallopian tubes > sigmoid/appendix > round ligaments

Question 6

What are the symptoms of endometriosis?

Answer 6

Three Ds:

• Dysmenorrhea
• Dyspareunia
• Dyschezia

Question 7

What usually worsens the pain of endometriosis?

Answer 7

Menses (although the pain can occur at any point during the cycle)

Question 8

Does endometriosis affect fertility?

Answer 8

Yes. Many patients are nulliparous.

Question 9

What are the signs of endometriosis on physical examination?

Answer 9

• tender/enlarged adnexae
• a retroverted uterus
• tender nodules in the uterosacral ligaments and cul-de-sac

Question 10

What is the gold standard for diagnosing endometriosis?

Answer 10

Direct visualization of the lesions during laparoscopy

Question 11

How are endometriosis lesions described?

Answer 11

Raised, blue-colored mulberry spots or brown-colored powder burns

Question 12

What are chocolate cysts?

Answer 12

Endometriomas formed when endometriosis invades the ovaries

Question 13

Describe the fluid within chocolate cysts.

Answer 13

Thick, dark blood

Question 14

What is the treatment for chocolate cysts?

Answer 14

Excision

Question 15

Does a negative laparoscopy reliably exclude endometriosis?

Answer 15

Yes

Question 16

Which medicines are used to treat endometriosis?

Answer 16

• Combination oral contraceptive pills (OCPs)/progestin
• androgens (danazol)
• GnRH agonists

Question 17

What class of medications can provide symptomatic relief in endometriosis?

Answer 17

NSAIDs

Question 18

How do danazol and GnRH agonists work?

Answer 18

Inhibit pituitary gonadotropin secretion leading to decreased ovarian estrogen production

Question 19

Are danazol and GnRH agonists as equally effective as OCPs?

Answer 19

Yes.But they have more side effects.

Question 20

What are side effects of danazol and GnRH agonists?

Answer 20

• hot flashes
• vaginal atrophy
• decreased bone density

Question 21

When is it appropriate to refer a patient with endometriosis for surgery?

Answer 21

• failed medical management
• severe pain
• desired pregnancy

Question 22

What is the conservative surgical option for patients who desire pregnancy?

Answer 22

Laparoscopic ablation and excision of implants and adhesions

Question 23

What is the definitive surgical option?

Answer 23

Hysterectomy with or without salpingoophorectomy