Endometriosis Flashcards
(18 cards)
Gold standard for diagnosis of endometriosis?
Laparoscopy +/- biopsy
1st line drugs
NSAIDs
low dose COCs/vaginal ring/patch
progestins
opioids
2nd line agents
GnRH antagonists
2 common symptoms in endometriosis
pelvic pain and infertility
GnRH analogues
nafarelin
gosorelin
leuprolide
Through what mechanism do NSAIDs reduce pain?
Reduce endometrial prostaglandin
How long can low dose COCs be continued for?
unlimited continuous use
Side effects of GnRH analogs
hypoestrogenic effects - risk of osteoporosis (due to reduced osteoblast and BMD)
-hot flashes
-depression
-increased lipids
What supplements should a patient take if stating GnRH analogs?
calcium and vitamin D - for bone health, OR bisphosphonates
Androgen agonist example
danazol
side effect of androgen agonists (danazol)
weight gain
dyslipidemia
acne
hirsutism
and anti-estrogen effects= hot flash, smaller breast size
(THINK OF PCOS AND INCR ANDROGENS)
how long is treatment of an androgen agonist usually?
6-9 months
When would you consider GnRH agonist therapy?
only when low dose COC therapy is ineffective or contraindicated.
when to start low dose COC?
if a patient has persistent pelvic pain; typically first line and easy to start, can be used for an unlimited duration
ectopic endometriosis
endometrial-like tissue (normally found in the uterus) grows outside the uterine cavity, often on the ovaries, fallopian tubes, or pelvic lining. growth leads to inflammation and pain (estrogen causes proliferation)
which drug class helps to treat ectopic endometriosis?
aromatase inhibitors (letrozole, anastrazole). prevents the conversion of androgen to estrogen, shrinking the endometrial lining
side effects of anastrazole?
hot flashes, sweating, osteoporosis, loss of appetite
Dosing of letrozole in fertility treatment?
Letrozole 2.5 mg po daily x 5 days (on days 3-7 of the cycle), increase dose gradually upto 7.5 mg daily on days 3-7 of cycle to induce OVULATION.
