Gyne Lecture 2

Front 1

What is endometriosis?

Back 1

Endometrial glands and stroma in extrauterine site

Hormonally responsive, similar to endometrium within uterus

Front 2

Etiology of endometriosis

Back 2

• retrograde menstruation and implantation (Sampson theory)
• metaplasia
• vascular of lymphatic dissemination

Front 3

Immunological etiology of endometriosis

Back 3

• lack of apoptosis
• natural killer/macrophage activity
• vascular endothelial growth factors
• chemoattractant cytokines
• angiogenesis

Front 4

Genetic etiology of endometriosis

Back 4

7-12% have first degree relative with endo diagnosis

Front 5

Histology of endometriosis

Back 5

• rectovaginal septum disease
• peritoneal disease
• ovarian disease

Front 6

Clinical presentation, most common, of endometriosis?

Back 6

Pelvic pain and dysmenorrhea and dyspareunia

Front 7

PE signs of endometriosis

Back 7

• adnexal mass
• localized/generalized pelvic tenderness
• uterosacral nodule/scarring
• fixed uterus
• coloured lesions in the vagina

Front 8

Gold standard of endometriosis diagnosis?

Back 8

laparoscopy

Front 9

Histological criteria of endometriosis diagnosis?

Back 9

2 or more of:

• endometrial epithelium
• endometrial glands
• endometrial stroma
• haemosideran laden macrophages

Front 10

Tissue confirmation diagnosis of endometriosis?

Back 10

• black = 94%
• white = 80%
• clear = 65%
• polyploid red = 75%
• flat red = 33%
• adhesions = 26%

Front 11

Treatment of endometriosis?

Back 11

Indications:

• pain
• infertility
• adnexal mass

Options:

• medical
• surgical

Front 12

Pain management of endometriosis?

Back 12

Analgesics or hormonal treatments

Front 13

rationale of hormonal treatment of endometriosis?

Back 13

• suppress ovulation
• create amenorrhea
• shrink endometriotic lesions
• not curative; symptom recurrence

Front 14

Who is surgery best reserved for?

Back 14

Women interested in immediate pregnancy or definitive treatment

Those with presence of an adnexal mass (endometrioma)

or when diagnosis is in doubt

Front 15

Definitive treatment for endometriosis?

Back 15

TAH + BSO (only 3.7% reoperated)

Front 16

Goal of hormonal therapies?

Back 16

Inducing endometrial atrophy by suppressing estrogen stimulation of endometrial proliferation

Front 17

First line treatment for dysmenorrhea?

Back 17

Combined OCP and NSAIDs

Front 18

Does surgical treatment for endometriosis improve pregnancy rate?

Back 18

Yes; by only 18%

Front 19

Fertility treatment for patients with endometriosis?

Back 19

• conservative treatment
• restore anatomy
• minimize adhesion formation
• some evidence for treating mild endometriosis

Front 20

What is the "gold standard" for treating endometriosis?

Back 20

GnRH antagonists

failure to response to such treatment should prompt considerations of an alternative diagnosis

Front 21

IVF fertility treatment for endometriosis?

Back 21

• IVR rates equivalentto surgery in women < 36 after 1-2 cycles
• success rates fall by > 50% after age 36

Front 22

Factors to consider when deciding to operate on mod/severe endometriosis?

Back 22

• Age
  
• Tubal damage
  
• Duration of infertility
  
• Pain level
  

Front 23

Women who have had severe symptoms of endometriosis in their reproductive years will have marked improvement in menopause. Why?

Back 23

Because estrogen no longer stimulates the endometrial epithelium

Front 24

What is adenomyosis?

Back 24

Endometrial tissue is found within myometrium

Front 25

What are the 3 Ds of enDometriosis?

Back 25

• Dysmenorrhea
  
• Dyspareunia
  
• Dyschezia (constipation)