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    Mohamad Hafyfy
    Endometriosis is a disease where endometrial tissue grows outside the uterine cavity, commonly on the ovaries and ligaments. It affects 10-20% of women and peaks between ages 30-45. The main symptoms are pelvic pain and infertility. Diagnosis involves ultrasound, MRI or laparoscopy. Staging ranges from minimal to severe disease. Treatment options include medications like combined oral contraceptives, progestogens or danazol to suppress hormones and symptoms. Surgery may be used for severe cases or to treat infertility.

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    Presentation 1

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    Mohamad Hafyfy
    48 views20 pages
    Endometriosis is a disease where endometrial tissue grows outside the uterine cavity, commonly on the ovaries and ligaments. It affects 10-20% of women and peaks between ages 30-45. The main symptoms are pelvic pain and infertility. Diagnosis involves ultrasound, MRI or laparoscopy. Staging ranges from minimal to severe disease. Treatment options include medications like combined oral contraceptives, progestogens or danazol to suppress hormones and symptoms. Surgery may be used for severe cases or to treat infertility.

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    Endometriosis is a disease where endometrial tissue grows outside the uterine cavity, commonly on the ovaries and ligaments. It affects 10-20% of women and peaks between ages 30-45. The main symptoms are pelvic pain and infertility. Diagnosis involves ultrasound, MRI or laparoscopy. Staging ranges from minimal to severe disease. Treatment options include medications like combined oral contraceptives, progestogens or danazol to suppress hormones and symptoms. Surgery may be used for severe cases or to treat infertility.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    48 views20 pages

    Presentation 1

    Uploaded by

    Mohamad Hafyfy
    Endometriosis is a disease where endometrial tissue grows outside the uterine cavity, commonly on the ovaries and ligaments. It affects 10-20% of women and peaks between ages 30-45. The main symptoms are pelvic pain and infertility. Diagnosis involves ultrasound, MRI or laparoscopy. Staging ranges from minimal to severe disease. Treatment options include medications like combined oral contraceptives, progestogens or danazol to suppress hormones and symptoms. Surgery may be used for severe cases or to treat infertility.

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    ENDOMETRIOSIS

    Definition

    Disease in which endometrial glands and stroma implant and grow in areas outside the lining of the uterine cavity most commonly on the ovaries, broad ligament, POD and uterosacral ligaments Can also be found on fallopian tube, bladder and large intestine and rarely in lungs, nasal passages and kidneys Endometriotic tissue responds to cyclical hormonal changes and therefore undergoes cyclical bleeding and local inflammatory reaction Healing and fibrosis can lead to adhesion between organs

    Incidence

    Present in 10-20% of women presenting to gynecologist Peak incidence between 30-45 years of age 25-50% of infertile women have endometriosis Remains as a hidden disease until other problems arise

    Aetiology

    Menstrual regurgitation and implantation


    transport of viable endometrial cells through retrograde menstruation Common found in women with genital tract abnormalities where there is obstruction to menstrual fluid

    Coelomic epi transformation


    De-differentiate of peritoneal cells lining the mullerian duct back to their primitive origin which then transform into endometrial cells This maybe due to hormonal stimuli or inflammatory irritation

    Aetiology

    Dissemination of endometrial cells through lymphatic and vascular systems. This explain the distant sites of endometriotic lesions Genetics - Studies have shown increased incidence in first-degree relatives of women with this disease Iatrogenic deposition of endometrial tissue has been found in some cases following gynecologic procedures and cesarean sections

    Symptoms

    Common - dysmenorrhea and pelvic pain Pelvic mass Alteration of menses Infertility Dyspareunia Bowel symptoms Urinary symptoms

    Vaginal examination

    Thickening or nodularity of uterosacral ligaments. Tenderness in the pouch of Douglas. Ovarian mass or mass due to adhesions of pelvic organs. Fixed retroverted uterus due to pelvic adhesions

    Diagnosis

    Ultrasound
    - TVS can detect gross endometriosis involving the ovaries (endometrioma)

    Imaging (CT or MRI)


    - can detect lesion >5mm - useful for presurgical planning in difficult case and for following progression

    Laparoscopy (gold standard)


    - direct visualization of endometriotic lesions and possibility of biopsy suspicious area and also staging of the disease

    Staging
    Stage I II Disease Minimal Mild Description A few superficial implants More and slightly deeper implants

    III

    Moderate

    Many deep implants, small endometriomas on one or both ovaries, and some filmy adhesions Many deep implants, large endometriomas on one or both ovaries, and many dense adhesions, sometimes with the rectum adhering to the back of the uterus

    IV

    Severe

    Infertility
    Ovarian function Luteolysis caused by prostaglandins Oocyte maturation defects Anovulation Luteinized unruptured follicle syndrome Altered prolactin release Impaired fimbrial oocyte pick-up Altered tubal mobility Deep dyspareunia reduced coital frequency Antibodies causing inactivation Macrophage phagocytosis immune reaction Luteal phase deficiency

    Tubal function

    Coital function Sperm function

    Early pregnancy failure

    Management

    Medical therapy - NSAIDs for pain relief - Combine oral contraceptive pills - Progestogens - Danazol - GnRH agonists

    COCPs

    Inhibiting ovulation Consist of synthetic estrogen and progesterone Prescribed to be taken continuously for an initial 6 mo To reduce the severity of dysmenorrhea and menstrual blood loss SE: weight gain, fluid retention, breast tenderness, arterial thrombosis, stroke, MI

    progestogens

    Synthetic drugs that mimic progesterone Medroxyprogesterone acetate has proven efficacy in pain suppression in both the oral and injectable depot preparations The use of levonogestrel intrauterine systems (LNGIUS) has been shown to be effective in achieving a long term therapy effect SE: weight gain, fluid retention, depression, and breakthrough bleeding

    Danazol

    synthetic version of the male hormone testosterone inhibits the release of FSH and LH by the pituitary gland decreases estrogen levels similar to menopause, stops ovulation improved symptoms in 89% of patients SE: deepening of the voice, abnormal hair growth, reduced breast size, water retention, weight gain , acne, irregular vaginal bleeding, muscle cramps Not commonly used agents due to alterations in lipid profile and liver function

    GnRH agonists

    GnRH analogs produce a hypogonadotrophichypogonadic state by down-regulation of the pituitary gland Treatment is usually restricted to monthly injections for 6 months. SE: reduced bone density, hot flashes and vaginal dryness Low estrogen effect: long term use can cause reduce bone density

    Surgical treatment

    Conservative surgery - laparoscopic with techniques such as diathermy, laser or excision - endometriotic cysts should not just be drained but the inner cyst lining should be excised and destroyed - LUNA is performed for uterosacral ligaments nodules - recurrent risk 30% and long term medical therapy is usually useful

    Definitive surgery - severe symptoms or progressive disease or completed family - total abdominal hysterectomy with bilateral salpingo oopherectomy (TAH BSO)

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