Endometriosis and Adenomyosis

Question 1

Most common cause of hospitalization of reproductive age women?

Answer 1

Endometriosis.

Question 2

Most common risk factor for endometriosis?

Answer 2

First degree relative.

Question 3

A 30 year old woman presents with cyclic pelvic pain beginning 1 week before menses, peaking 1 day before menses, that subsides after menses

1. Diagnosis?
2. Common complication?

Answer 3

1. Endometriosis

2. Infertility (dense adhesions cause tubal obstruction)

Question 4

Diagnostic test for endometriosis?

Common finding?

Answer 4

Direct visualization with laparoscopy or laparotomy. 
Chocolate cysts (endometrioma).

Question 5

Treatment of endometriosis in women who don’t want any more kids?

Answer 5

Total hysterectomy and bilateral salpino-oophorectomy.

Question 6

Role of medical management for patients wishing to conceive with endometriosis?

Answer 6

None. Temporizing measures.

Question 7

Definition of adenomyosis?
Cause?
Where is disease most extensive?
Findings on physical exam?

Answer 7

Extension of endometrial tissue into the uterine myometrium.
High estrogen causes hyperplasia of basalis layer.
Fundus and posterior uterine wall.
Diffusely enlarged globular boggy uterus.

Question 8

Definition of adenomyoma?

How do these differ from leiomyomas?

Answer 8

Well circumscribed collections of smooth muscles cells endometrial glands/stroma.
Not encapsulated.

Question 9

Most common symptoms of adenomyosis?

Answer 9

Menorrhagia, secondary dysmenorrhea (or both).

Question 10

Which is more receptive to hormonal treatment therapies Adenomyosis or Endometriosis?

Answer 10

Endometriosis.

Question 11

Diagnostic tests for adenomyosis?

Definitive treatment?

Answer 11

Pelvic ultrasound (MRI is better though - will rule out fibroids). 
Hysterectomy is definitive test and treatment.