Endometriosis Flashcards
Typical symptoms of endometriosis
Dysmenorrhea, dyspareunia present in week preceding/during menses
Nodularity along back of uterus and uterosacral ligaments
DDx:
Adenomyosis would be associated with heavy periods and uterine enlargement, not normal periods
Fibromyalgia pain would not be confined to perimenstrual week
Risk factors for endometriosis
Cervical stenosis - from prior cervical surgery (eg LEEP)
Diagnosis of endometriosis
Exploratory surgery and biopsies are definitive
However, can initially treat based on clinical presentation alone
No imaging study or blood test
What would you do for a patient with painful, heavy menses resistant to ibuprofen and OCPs?
Diagnostic laparoscopy for likely endometriosis or adhesions
Endometriosis treatment
NSAIDs for pain
OCP (progestin suppresses endometrial tissue) without week of placebo pills
GnRH agonists (eg leuprolide, goserelin, nafarelin) - short-term only; side effects of menopausal symptoms, bone loss
Danazol - synthetic androgen with associated side effects
Surgical removal of implants/endometriomas - for those who fail medical treatment and/or are planning pregnancy in near future
Total hysterectomy/BSO (if not at young age)
Echogenic, homogeneous ground-glass cyst of ovary
Endometrioma
DDx:
Serous cystadenoma and follicular cyst would be anechoic
Matura teratoma would be heterogeneous with calcification
Which medication class for endometriosis has fastest onset of action?
GnRH antagonists (eg elagolix)
What is norethindrone?
Synthetic progestin - suppresses endometrial growth but often takes >1 cycle for improvement in symptoms
Common complication of endometriosis
Infertility - due to intraperitoneal inflammation and fibrosis; inflammation decreases sperm motility while adhesions distort pelvic anatomy and can cause tubal obstruction
Endometriosis appearance on US
Homogenous cyst with internal echoes (ground glass)
