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    Endometriosis

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    Ano Dzamelashvili
    Endometriosis is a disorder where tissue similar to the uterine lining grows outside the uterus, most commonly on the ovaries and fallopian tubes. It causes painful periods, pain with sex, and infertility. The cause is unknown but is thought to involve cells traveling through the body during periods. Diagnosis involves laparoscopy to view the tissue growths. Treatment options include pain medications, hormonal birth control, surgery to remove growths, and in more severe cases, hysterectomy. Managing symptoms is the goal as the condition often recurs after stopping treatments.

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    Endometriosis

    Uploaded by

    Ano Dzamelashvili
    24 views4 pages
    Endometriosis is a disorder where tissue similar to the uterine lining grows outside the uterus, most commonly on the ovaries and fallopian tubes. It causes painful periods, pain with sex, and infertility. The cause is unknown but is thought to involve cells traveling through the body during periods. Diagnosis involves laparoscopy to view the tissue growths. Treatment options include pain medications, hormonal birth control, surgery to remove growths, and in more severe cases, hysterectomy. Managing symptoms is the goal as the condition often recurs after stopping treatments.

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    Endometriosis is a disorder where tissue similar to the uterine lining grows outside the uterus, most commonly on the ovaries and fallopian tubes. It causes painful periods, pain with sex, and infertility. The cause is unknown but is thought to involve cells traveling through the body during periods. Diagnosis involves laparoscopy to view the tissue growths. Treatment options include pain medications, hormonal birth control, surgery to remove growths, and in more severe cases, hysterectomy. Managing symptoms is the goal as the condition often recurs after stopping treatments.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    24 views4 pages

    Endometriosis

    Uploaded by

    Ano Dzamelashvili
    Endometriosis is a disorder where tissue similar to the uterine lining grows outside the uterus, most commonly on the ovaries and fallopian tubes. It causes painful periods, pain with sex, and infertility. The cause is unknown but is thought to involve cells traveling through the body during periods. Diagnosis involves laparoscopy to view the tissue growths. Treatment options include pain medications, hormonal birth control, surgery to remove growths, and in more severe cases, hysterectomy. Managing symptoms is the goal as the condition often recurs after stopping treatments.

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    Endometriosis

    Endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the
    inside of your uterus - the endometrium - grows outside your uterus. Endometriosis most commonly
    involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial-like tissue
    may be found beyond the area where pelvic organs are located. Average age at diagnosis is 27 years, but
    endometriosis also occurs among adolescents.

    Etiology and Pathophysiology of Endometriosis


    The most widely accepted hypothesis for the pathophysiology of endometriosis is that
    endometrial cells are transported from the uterine cavity during menstruation and implanted at
    ectopic sites.
    Microscopically, endometriotic implants consist of glands and stroma histologically identical to
    intrauterine endometrium. These tissues contain estrogen and progesterone receptors and thus
    usually grow, differentiate, and bleed in response to changes in hormone levels during the
    menstrual cycle; also, some endometriotic implants produce estrogen and prostaglandins.
    Implants may become self-sustaining or regress, as may occur during pregnancy.
    Some patients with minimal endometriosis and normal pelvic anatomy are infertile; reasons for
    impaired fertility are unclear but may include the following:

     Increased incidence of luteinized unruptured ovarian follicle syndrome


     Increased peritoneal prostaglandin production or peritoneal macrophage activity that
    may affect fertilization, sperm, and oocyte function
     Nonreceptive endometrium
    Potential risk factors for endometriosis are:

     Family history of 1st-degree relatives with endometriosis


     Delayed childbearing or nulliparity
     Early menarche
     Late menopause
     Shortened menstrual cycles (< 27 days) with menses that are heavy and prolonged (> 8
    days)
    Potential protective factors seem to be:

     Multiple births
     Prolonged lactation
     Late menarche
     Long-term use of low-dose oral contraceptives
     Regular exercise

    Symptoms and Signs of Endometriosis


    The classic triad of symptoms is dysmenorrhea, dyspareunia, and infertility. Pelvic pain,
    specifically pain preceding or during cycle and during sexual intercourse, is typical and can be
    progressive and chronic. Some women with extensive endometriosis are asymptomatic; some
    with minimal disease have unbearable pain. Dysmenorrhea is an important diagnostic clue,
    particularly if it begins after several years of relatively pain-free menses.
    Symptoms often lessen or resolve during pregnancy. Endometriosis tends to become inactive
    after menopause because estrogen and progesterone levels decrease.
    Symptoms can vary depending on location of implants.

     Ovaries: Formation of an endometrioma, which occasionally ruptures or leaks, causing


    acute abdominal pain and peritoneal signs
     Bladder: Dysuria, hematuria, suprapubic or pelvic pain, urinary frequency
     Large intestine: Pain during defecation, abdominal bloating, diarrhea or constipation, or
    rectal bleeding
     Extrapelvic structures: Vague abdominal pain

    Diagnosis of Endometriosis
     Direct visualization, usually during pelvic laparoscopy
     Sometimes biopsy
    Diagnosis of endometriosis is suspected based on typical symptoms. Misdiagnosis as pelvic
    inflammatory disease, urinary tract infection, or irritable bowel syndrome is common.
    The diagnosis of endometriosis must be confirmed by direct visualization, usually via pelvic
    laparoscopy but sometimes via laparotomy, vaginal examination, sigmoidoscopy, or cystoscopy.
    Biopsy is not required, but results confirm the diagnosis.
    Macroscopic appearance and size of implants vary during the menstrual cycle. As the blood in
    the lesions oxidizes, they turn purple, then brown; they then turn to bluish or purplish brown
    spots that are > 5 mm and resemble powder burns.
    Microscopically, endometrial glands and stroma are usually present. Stromal elements in the
    absence of glandular elements indicate a rare variant of endometriosis called stromal
    endometriosis.
    No laboratory tests contribute to the diagnosis of endometriosis.

    Treatment of Endometriosis
     Nonsteroidal anti-inflammatory drugs (NSAIDs) for discomfort
     Estrogen-progestin contraceptives
     Drugs to suppress ovarian function
     Conservative surgical resection or ablation of endometriotic tissue, with or without
    drugs
     Total abdominal hysterectomy with or without bilateral salpingo-oophorectomy if
    disease is severe and the patient has completed childbearing
     Symptomatic medical treatment begins with analgesics (usually NSAIDs) and hormonal
    contraceptives.
    Drugs and conservative surgery are used mainly to control symptoms. In most patients,
    endometriosis recurs within 6 months to 1 year after drugs are stopped unless ovarian function
    is permanently and completely ablated. Endometriosis may also recur after conservative
    surgery.
    Conservative surgical treatment of endometriosis is excision or ablation of endometriotic
    implants and removal of pelvic adhesions during laparoscopy. More definitive treatment must
    be individualized based on the patient's age, symptoms, and desire to preserve fertility and on
    the extent of the disorder.
    Total abdominal hysterectomy with or without bilateral salpingo-oophorectomy is considered
    definitive treatment of endometriosis. It helps prevent complications and modify the course of
    disease as well as relieving symptoms; however, endometriosis can recur.

    Drug therapy
    Drugs that suppress ovarian function inhibit the growth and activity of endometriotic implants.
    The following are commonly used:

     Continuous combination (estrogen-progestin) contraceptives


     The following drugs are usually used only when women cannot take combination oral
    contraceptives or when treatment with combination oral contraceptives is ineffective:
     Progestins
     Gonadotropin-releasing hormone (GnRH) agonists and antagonists
     Danazol
    Drug treatment does not change fertility rates in women with minimal or mild endometriosis.

    Surgery
    Most women with moderate to severe endometriosis are treated most effectively by ablating or
    excising as many implants as possible while restoring pelvic anatomy and preserving fertility as
    much as possible. Superficial endometriotic implants can be ablated. Deep, extensive implants
    should be excised.
    Specific indications for laparoscopic surgery include

     Moderate to severe pelvic pain that does not respond to drugs


     Presence of endometriomas
     Significant pelvic adhesions
     Fallopian tube obstruction
     A desire to maintain fertility
     Pain during intercourse
    Lesions are usually removed via a laparoscope; peritoneal or ovarian lesions can sometimes be
    electrocauterized, excised, or, uncommonly, vaporized with a laser. Endometriomas should be
    removed because removal prevents recurrence more effectively than drainage. After this
    treatment, fertility rates are inversely proportional to the severity of endometriosis. If resection
    is incomplete, GnRH agonists are sometimes given during the perioperative period, but whether
    this tactic increases fertility rates is unclear. Laparoscopic resection of the uterosacral ligaments
    with electrocautery or a laser may reduce midline pelvic pain.
    Hysterectomy with or without ovarian conservation should usually be reserved for patients who
    have moderate to severe pelvic pain, who have completed childbearing, and who prefer a
    definitive procedure. Hysterectomy is done to remove adhesions or implants.
    If women < 50 require hysterectomy with bilateral salpingo-oophorectomy, supplemental
    estrogen should be considered to prevent menopausal symptoms. Also, connected continuous
    progestin therapy is often recommended because if estrogen is given alone, residual tissue may
    grow, resulting in recurrence. If symptoms persist after salpingo-oophorectomy in women > 50,
    continuous progestin therapy alone can be tried.

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