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30 Cards in this Set
- Front
- Back
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Endometriosis - Definition
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The presence of endometrial tissue outside the uterus resulting in pelvic pain and infertility.
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Endometriosis - Endometriosis can present anywhere in the body (True/False)
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True.
However usually limited to pelvic area: ovaries, fallopian tube, bowel, bladder, rectum. |
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Endometriosis - Pathophysiology
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Endometrial cells implanting outside the uterus.
The endometrial tissue contains E, P and androgens and responds to body's cyclic release during cycle. High E causes the tissue to grow while androgens cause them to atrophy. Withdrawal of E and P cause tissue to bleed, causing scarring and adhesion. |
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Endometriosis - The bigger the cyst, the more pain. (True/False)
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False.
Can have large cysts with little pain and vice versa. |
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Endometriosis - Purported mechanism for pain is ___.
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Prostaglandins.
Compression of surrounding nerve fibers or adjacent structures. Chemical peritoneal irritation by leaking endometrioma. |
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Endometriosis - Purported mechanism for infertility is ___.
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Scarring of fallopian tube causing blockage or distorted pelvic structure.
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Endometriosis - Prevalance is about ___ % of women of reproductive age.
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5-10%
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Endometriosis - Endometriosis affects ___ % of women experiencing infertility.
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30% (3 in 10)
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Endometriosis - Endometriosis affects ___ % of women experiencing chronic pelvic pain.
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70% (7 in 10)
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Endometriosis - How to differentiate between endometriosis pain and dysmennorhea pain?
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Age of patient.
Endometriosis presents in late 20s and early 30s who have delayed pregnancies. Dysmennorhea presents in teen years. |
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Endometriosis - There is no difference in prevalence between races (True/False)
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False.
Most common in Asian, then Caucasians, then African race. |
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Endometriosis - Risk factors (6)
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HAREMS:
- Heavy menses > 7 days - Autoimmune disease - Race - Early menarche - Maternal inheritance - 3-10X risk if 1st degree maternal relative (mother or sister) has/had it - Short menstrual cycle (<27 days) |
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Endometriosis - Smoking and OCP use increase incidence of endometriosis (True/False)
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False.
Decreased incidence in smokers and OCP users. |
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Endometriosis - Most widely held theory on cause of endometriosis is ___.
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Retrograde menstruation theory.
Endometrium shed during menstruation flows back into fallopian tubes and implants in pelvic area. |
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Endometriosis - Other theories of endometriosis are ___ (3).
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- Immunologic therory - presence of abnormal B and T cell function
- Coelomic metaplasia theory- change from epithelium tissue to endometrium tissue - Vascular/Lymphatic theory - spread via vascular or lymphatic tissue |
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Endometriosis - Symptoms (4)
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- Pain (Pelvic, Sexual, Lower back, Defecation)
- GI (constipation, urinary disturbances) - Premenstrual spotting, heavy irregular bleed - Fatigue |
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Endometriosis - Endometriosis should be suspected if have any symptoms plus ____.
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Subfertility
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Endometriosis - Gold standard for diagnosis is not U/S or MRI but ___.
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Laparascopy and histological study
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Endometriosis - 1st Line Pharmacological treatment
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- CHC - combined hormonal contraceptives
- Suppress ovulation and decrease hormonal levels (ethinyl estradiol in OCP weaker activity than body's own) - Menstrual cycle is shorter, lighter, and more regular - Good for women who have no desire to get pregnant, cheap and tolerable side effects |
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Endometriosis - NSAIDS in treatment
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- 1st line for mild symptoms and if don't want pregancy (CI)
- Used with OCPs to control pain and inflammation - Continuously or intermittent, try another if one doesnt work |
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Endometriosis - 2nd line Pharmacological treatment
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- Progestins
- Work by inhibiting ovulation, reduce hormone levels, and induce endometrial atrophy - Equally effective to OCPs but SE limit use |
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Endometriosis - SE of Progestins
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- Breakthrough bleeding
- Weight gain - Fluid retention - Mood changes |
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Endometriosis - New progestin indicated for the management of pelvic pain associated with endometriosis is ___
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Dienogest(Visanne)
- Progestogenic effects (anti-androgen) and acts by decreasing estrogen production - 1/3 of effect of cyproterone acetate |
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Endometriosis - 3rd line Pharmacological treatment
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GnRH agonists
- Bind to receptors in pituitary and cause initial release of FSH/LH. However constant agonism due to long t1/2 causes negative feedback and downregulation. - End result is hypoestrogenic state (pseudomenopausal) |
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Endometriosis - Efficacy of GnRH agonists is ___ % after 6 months
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85-100%
However still 3rd line due to AE profile |
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Endometriosis - GnRH agonists - Name them
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Injectibles:
- Leuprolide depot - Goserelin - Buserelin - Triptorelin Intranasal sprays: - Nafarelin - Buserelin |
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Endometriosis - Hypoestrogenic state symptoms: (4)
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Similar to menopause:
- Bone loss (beyond 6 months=permanent) - Vasomotor symptoms (hot flash, night sweats, vaginal dryness, insomnia) - Headache - Decreased libido - Mood swings |
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Endometriosis - "Add back" treaments - What are they and why are they necessary?
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With GnRH therapy, a low dose estrogen with low dose progestin is added on from beginning of therapy.
To counteract bone loss and vasomotor symptoms, though not enough to stimulate endometrial growth. |
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Endometriosis - ___ is a synthetic androgen derived from testosterone used to produce pseudomenopausal effect by increasing androgen levels and decreasing estrogen levels
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Danazol.
Use is limited due to SE profile (pseudomenopause plus androgenic effect --> hisutism, acne, decreased breast size, increased LDL) |
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Endometriosis - Aromatase inhibitors is yet another class in treating endometriosis (True/False)
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True.
Aromatase is a key enzyme in production of estrogen and is expressed in endometrial implants. |
