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    ENDOMETRIOSIS

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    Peterson Wachira Hsc
    Endometriosis and adenomyosis are abnormal growths of endometrial tissue outside and within the uterus respectively. Endometriosis commonly affects the ovaries, pelvic peritoneum and ligaments. It causes pelvic pain and infertility. Adenomyosis causes an enlarged soft uterus and heavy bleeding. Treatment options depend on severity and desire for future fertility, ranging from medication to surgery. Hysterectomy provides a definitive cure for adenomyosis.

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    ENDOMETRIOSIS

    Uploaded by

    Peterson Wachira Hsc
    25 views17 pages
    Endometriosis and adenomyosis are abnormal growths of endometrial tissue outside and within the uterus respectively. Endometriosis commonly affects the ovaries, pelvic peritoneum and ligaments. It causes pelvic pain and infertility. Adenomyosis causes an enlarged soft uterus and heavy bleeding. Treatment options depend on severity and desire for future fertility, ranging from medication to surgery. Hysterectomy provides a definitive cure for adenomyosis.

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    Endometriosis

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    Endometriosis and adenomyosis are abnormal growths of endometrial tissue outside and within the uterus respectively. Endometriosis commonly affects the ovaries, pelvic peritoneum and ligaments. It causes pelvic pain and infertility. Adenomyosis causes an enlarged soft uterus and heavy bleeding. Treatment options depend on severity and desire for future fertility, ranging from medication to surgery. Hysterectomy provides a definitive cure for adenomyosis.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    25 views17 pages

    ENDOMETRIOSIS

    Uploaded by

    Peterson Wachira Hsc
    Endometriosis and adenomyosis are abnormal growths of endometrial tissue outside and within the uterus respectively. Endometriosis commonly affects the ovaries, pelvic peritoneum and ligaments. It causes pelvic pain and infertility. Adenomyosis causes an enlarged soft uterus and heavy bleeding. Treatment options depend on severity and desire for future fertility, ranging from medication to surgery. Hysterectomy provides a definitive cure for adenomyosis.

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    ENDOMETRIOSIS/ADENOMYOSIS

    DEFINITION
    ENDOMETRIOSIS: ADENOMYOSIS:
    Abnormal growths of Presence of endometrial
    tissue histologically glands and stroma
    resembling the within the myometrium
    endometrium in on hitological
    locations other than the examination.
    uterine lining.
    ENDOMETRIOSIS
    EPIDEMIOLOGY
     Endometriosis is a disease of reproductive age
    women.
     Rarely found in men receiving oestrogen
    therapy and in post menopausal women.
     Exact prevalence is unknown but estimated at
    10-20% of reproductive age women and
    accounts for many admission in the
    reproductive age.
    AETIOLOGY
    The cause of endometriosis is unknown. There
    are three theories:
     Retrograde menstruation theory.
     Theory of coelomic metaplasia.
     Immunological theory.
    PATHOLOGY
     Endometrial lesions appear as red velvety
    implants on the peritoneal surface. Further
    growth gives them a cystic, darkblue or black
    appearance. Lesions may grow to 5-10 mm
    surrounded by extensive adhesions. In the
    ovaries the cysts may enlarge to several cm;
    endometriomas or ‘chocolate cysts’.
    Commonest sites
     Ovary-50%. Pod, utero-sacral
    ligaments,posterior visceral surface of the
    uterus,broad ligament, bowel,bladder&ureters.
     Rare - deep in the cervix,vaginal
    fornices,wounds contaminated with
    endometrial tissue.
     Distant - out of the pelvis-
    lungs,brain&kidney.
    CLINICAL FINDINGS
     Infertility – The prevalence of endometriosis doubles
    in infertile women.
     History – pelvic pain is the cardinal symptom.
    Dyspareunia, haematuria, haematochezia.
     Physical examination – Tender nodules in the
    posterior vaginal fornix and cervical excitation
    tenderness. Cystic bluish lesions on inspection of the
    vagina, perineum and scars.
     Investigation – confirm by laparoscopy\ laparotomy
    and histology.
    TREATMENT
     Depends on desire for future fertility, symptoms,
    disease stage and age of the patient.
     Minimal disease – observe on NSAIDS and
    prostaglandin inhibitors.
     Moderate – pseudo pregnancy – ocps.
     Severe disease – pseudomenopause – e.g.. Danazol,
    gnrh agonists - Buserelin , Goserelin, Leuprorelin .
     Surgery – excision & adhesionolysis, For those with
    DFS – TAH + BSO, Appendicectomy and excision of
    all lesions.
    PROGNOSIS
     Counseling after diagnosis and staging is vital
    for decision of management mode.
     May reccur even after definitive surgery.
    ADENOMYOSIS
    EPIDEMIOLOGY
     Adenomyosis is generally a disease of
    multiparous women over age of 30 years.
     Incidence range 8-40% in routine sampling of
    hysterectomy specimens.
    AETIOLOGY
     The cause of adenomyosis is not exactly
    known but thought to be direct contamination
    of endometrial surface where isolate islands
    have lost the connection with the surface
    endometrium from fibrosis or musculature.
    PATHOLOGY
     Adenomyosis causes an enlarged diffuse soft
    uterus with a whorlike trabecular cut surface
    CLINICAL FINDINGS
     Hypermenorrhoea – 50% of cases,
    Increasingly severe dysmenorrhoea – 30% of
    cases.
     Diagnosis not pre operative in 2\3 of patients.
     Examination – Tender softened uterus pre
    menstrual.
     Investigation – not helpful.
    TREATEMENT
     Hysterectomy is the definitive treatment but
    depends on desire for future fertility.
     Chemotherapy – ocps reduce pain and
    bleeding.
     DXT – destroys ovaries and reduces I.e. for
    those who cannot stand surgery.
     Prognosis – Hysterectomy is curative.

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