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    Endometriosis: Gynecology 5 Course 1 Obstetrical and Gynecological Clinic MMA

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    Ann Elly
    This document provides information about endometriosis. It defines endometriosis as the presence of endometrial tissue outside the uterine cavity, most commonly found in the ovaries, broad ligaments, cul-de-sac of Douglas, and rectovaginal septum. It discusses the theories of etiology, epidemiology with risk factors like early menarche, symptoms like dysmenorrhea and dyspareunia, diagnostic tests, and treatment options including medications, surgery, and pain management.

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    Endometriosis: Gynecology 5 Course 1 Obstetrical and Gynecological Clinic MMA

    Uploaded by

    Ann Elly
    30 views23 pages
    This document provides information about endometriosis. It defines endometriosis as the presence of endometrial tissue outside the uterine cavity, most commonly found in the ovaries, broad ligaments, cul-de-sac of Douglas, and rectovaginal septum. It discusses the theories of etiology, epidemiology with risk factors like early menarche, symptoms like dysmenorrhea and dyspareunia, diagnostic tests, and treatment options including medications, surgery, and pain management.

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    En Dome Trios Is

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    This document provides information about endometriosis. It defines endometriosis as the presence of endometrial tissue outside the uterine cavity, most commonly found in the ovaries, broad ligaments, cul-de-sac of Douglas, and rectovaginal septum. It discusses the theories of etiology, epidemiology with risk factors like early menarche, symptoms like dysmenorrhea and dyspareunia, diagnostic tests, and treatment options including medications, surgery, and pain management.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    30 views23 pages

    Endometriosis: Gynecology 5 Course 1 Obstetrical and Gynecological Clinic MMA

    Uploaded by

    Ann Elly
    This document provides information about endometriosis. It defines endometriosis as the presence of endometrial tissue outside the uterine cavity, most commonly found in the ovaries, broad ligaments, cul-de-sac of Douglas, and rectovaginal septum. It discusses the theories of etiology, epidemiology with risk factors like early menarche, symptoms like dysmenorrhea and dyspareunia, diagnostic tests, and treatment options including medications, surgery, and pain management.

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    Endometriosis

    Gynecology 5th course 1st Obstetrical and Gynecological Clinic MMA

    Definition of Endometriosis
    presence of endometrial tissue, composed of glands and stroma, at sites outside endometrial cavity most common sites

    ovary broad ligament cul-de-sac of Douglas rectovaginal septum laparotomy scars

    endometrial tissue responds cyclically to estrogen severity of pain unrelated to extent of disease
    There may be more pain associated with active lesions in mild disease than with adhesions in severe disease swelling producing local inflammation

    commonly occurs in women in 20s and 30s major cause of infertility


    tends not to occur before menarche or after menopause

    Theories for Etiology


    Sampsons theory of retrograde menstruation Halbans lymphatic spread theory Meyers mullerian metaplasia theory

    metaplasia of mesothelial cells into endometrial epithelium under some unidentified influence, such as repeated inflammation

    Hematogenous spread

    Epidemiology

    found equally among all races more likely to occur and progress in women with
    early menarche in those with menstrual flow exceeding seven days cycles of less than 27 days years of menstruation uninterrupted by pregnancy family history of endometriosis

    Incidence
    10-15 % of women of reproductive age 40-50 % of women undergoing surgery for evaluation of infertility average age at diagnosis is 28

    Risk factors

    Single/nulliparous Early menarche Non-oral contraception Shorter cycle/longer duration of flow Dysplastic naevus syndrome, melanoma

    History

    most common symptoms


    dysmenorrhea dyspareunia (especially on deep penetration) perimenstrual back pain infertility

    other symptoms reported


    dyschezia (difficulty in defecating) abdominal pain irregular bleeding patterns, especially premenstrual spotting

    less common symptoms


    urgency in urination hematuria rectal bleeding

    Physical Exam Findings


    may appear normal if lesions = small & few advanced disease

    cervical displacement of 1 cm or more to the left or right of midline bimanual exam: tenderness and nodularity of the uterosacral ligaments and posterior cul-desac(Douglas space) are detected adnexal masses that vary in size, shape, and consistency and may be asymmetric, fixed, cystic, or indurated fixed retroversion of the uterus

    Diagnostic Tests
    CA-125 elevated (Tumour marker) FBC normal ESR normal Diagnostic laparoscopy

    Endometriosis on /in the Ovary

    Forms a dark, chocolate cystic mass.

    Differential Diagnoses

    chronic PID recurrent acute salpingitis hemorrhagic corpus luteum benign or malignant ovarian neoplasm ectopic pregnancy adenomyosis

    Asymptomatic diaphragmatic endometriosis

    Treatment Plan
    psychosocial intervention medications

    Danazol (ovarian inhibitor) progesterones combined Oral Contraceptives gonadotropin-releasing hormone agonists (GnRH-a)
    Lupron injection qmo x 6 mos Synarel nasal spray bid x 6 mos

    surgical interventions: conservative vs. definitive

    GnRH analogs
    Decreases secretion of gonadotropins Major concerns are

    Cost Parenteral administration Potential for accelerated bone mineral loss Hot flushes & hypo-estrogen states

    Treatment of pain
    NSAIDS: all significantly better than placebo, studies vary which one is best Naproxen >mefanemic acid>aspirin Naproxen=ibuprofen Naproxen only drug with significant SEs

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