Endometriosis

Question 1

Endometriuoisis

Answer 1

Tissue similar to endometrium is found outside the uterus

Responds to hormones just like endometrial tissue

• Increase in glandular and vascular composition
• Bleeding causes irritation to surrounding tissues
• Development of fibrous scar tissue and adhesions

Question 2

4 stages

Answer 2

1. minimal: endometrial implants haven’t pread or attached to any particular areas. Period and digestion problems
2. Mild: implants gat placed at deeper level on one site or there may be multiple sites with implants
3. Moderate: endometrial tissues growth and spread beyond pelvic cavity. Edometriosis symptoms are visible
4. Severe: deep implants, cysts and adhesions. Severe pain, infertility and chronic digestive issues

Question 3

Incidence and causes

Answer 3

Incidence: 1/10 women ages 15-49

Causes
Retrograde movement of menstrual blood out into pelvic cavity
Others
-Genetics
-Immune system disorders (lack ability to recognize abnormal tissue growth)
-Metaplasia (cell changes into a different type of cell)
-Endometrial cell transport via blood or lymph to other body parts

Question 4

Locations

Answer 4

Pelvic peritoneum
Ovaries
Fallopian (uterine) tubes / Oviducts
Behind the uterus
Uterine ligaments
Recto-vaginal septum (connective tissue between the vagina and rectum)
Bladder and urethra
Intestines

Question 5

Symptoms

Answer 5

Painful menstrual periods – dysmenorrhea
Heavy bleeding during period
-Fatigue
Severe back pain during period
Chronic pelvic pain
Pain at ovulation or during sexual intercourse
Painful bowel movements
-Diarrhea or constipation
Blood in stool or urine
Fertility problems

Question 6

Complications

what percent become infertile?

Answer 6

Depending on location
Prevents ovulation
Blocks or distorts oviducts
May also damage sperm or egg
Result:  Infertility (30-40%)

Cancer risk?
No increased risk of ovarian cancer
Endometriosis-associated adenocarcinoma – rare type of cancer

Question 7

Diagnosis

Answer 7

Pelvic exam
-Palpate for cysts or scars

Ultrasound (high frequency sound waves)

• Provides images of reproductive organs
• Identification of cysts (endometriomas)

MRI (magnetic field and radio waves)
-More detailed images (helps with surgical planning - size and location)

Laparoscopy confirmation (general anesthesia and laparoscope insertion)
-Location, size, biopsy (tissue sampling)
-Provides option for treatment
Removal of implants (endometrial patches)

Question 8

Non surgical treatments: contraceptives, GnRH agonists/antagonists, Progestin, Aromatase inhibitors

Answer 8

Contraceptives

• Goal: lighter, shorter menstrual flow
• Reduces estrogen levels and prevents ovulation and endometrial growth

GnRH agonists and antagonists

• Goal: block ovarian hormone production to decrease estrogen and prevent menstruation
• Agonists – ultimately interfere with pulsatile release of GnRH after initial surge in LH and FSH (downregulation in pituitary gland) – mimic menopausal symptoms
• Antagonists – prevent signaling to ovaries to release estrogen

Progestin

• Goal: stop menstruation and subsequent growth of implants
• Constant low levels causes endometrial thinning and reduced implant growth

Aromatase inhibitors

• Enzyme that converts Testosterone to Estrogen is inhibited
• Decreases amount of estrogen