15. Endometriosis and Adenomyosis

Question 1

Endometriosis

Pathogenesis

Answer 1

Marked by the presence of endometrial tissue (glands and stroma) outside the endometrial cavity

Endometrial tissue can be found anywhere in the body, but the most common sites = ovary and pelvic peritoneum including the anterior and posterior cul de sacs

Question 2

Hallmark of endometriosis

Answer 2

Cyclic pelvic pain beginning 1 or 2 weeks before menses, peaking 1-2 days before the onset of menses, and subsiding at the onset of menses

Question 3

The ovary itself can develop large cystic collection of endometriosis filled with thick, dark, old blood and debris known as _______

Answer 3

Endometriomas or chocolate cysts

Question 4

What are complications of endometriosis?

Answer 4

• Intra-abdominal inflammation and bleeding –>
  
  • Scarring
  • Pain
  • Adhesion formation
• –> Infertility + chronic pelvic pain

Question 5

Endometriosis can be treated medically

Answer 5

• NSAIDs
• OCPs
• Progestins
• Danazol
• GnRH agonists

Question 6

What is adenomyosis?

Answer 6

Extension of endometrial tissue into the myometrium making the uterus diffusely enlarged, boggy, and globular

Question 7

What is the most effective temporary means of treating the symptoms of adenomyosis?

Answer 7

Levonorgestrel-containing IUD

Question 8

Pt. on pelvic U/S has a 5 cm cystic ovarian mass thought to be endometrioma… it persists in repeat U/S 8 weeks later and pt is still symptomatic.

What is the most appropriate next step in her care?

Answer 8

Schedule diagnostic laparoscopy with left ovarian cystectomy

B/c of her significant symptoms and findings of persistent endometrioma, laparoscopy with planned cystectomy is the best option for her. Large endometriomas are not likely to resolve on their own with time in contrast with functional ovarian cysts. They are also unlikely to respond to medical mgmt with an OCP or GNRH agonist.