Endometriosis & Adenomyosis || with 100% Errorless
Solutions.
What's endometriosis? correct answers Endometriosis is the presence of endometrial tissue
(glands and stroma) outside the endometrial cavity.
Most common sites? correct answers Endometrial tissue can be found anywhere in the body, but
the most common sites are the ovary and the pelvic peritoneum. Other common sites are in the
most dependent parts of the
pelvis including the uterosacral ligaments, the anterior and posterior cul-de-sacs, and the
posterior uterus and broad ligaments. Although not commonly found, endometriosis has been
identified in the lung and brain.
What's an endometrioma? correct answers Endometriosis in the ovary.
How do endometrial implants cause symptoms? correct answers by disrupting normal tissue,
forming adhesions and fibrosis, and causing severe inflammation.
Does the severity of symptoms correlate with the amount of endometriosis? correct answers No.
Women with widely disseminated endometriosis or a large endometrioma may experience little
pain, whereas women with
minimal disease in the cul-de-sac may suffer severe pain.
Three main theories regarding etiology of endometriosis? correct answers (1) Halban theory:
endometrial tissue *transported via the lymphatic system* to various sites in the pelvis, where it
grows ectopically.
(2) Meyer: multipotential cells in peritoneal tissue undergo *metaplastic transformation* into
functional endometrial tissue.
(3) Sampson suggests that endometrial tissue is transported through the fallopian tubes during
*retrograde menstruation*
Incidence of endometriosis? correct answers 10-15%
Age group? correct answers It is found almost exclusively in women of
reproductive age, and is the single most common reason for hospitalization of women in this age
group. Approximately 20% of women with chronic pelvic pain and 30% to 40% of women with
infertility have endometriosis.
Risk factors for endometriosis correct answers Women with *first-degree relatives* (mother or
sisters) with endometriosis are seven times more likely to develop the disorder than women
without this risk factor. A relationship has also been demonstrated between endometriosis and
some *autoimmune disorders (e.g., lupus).* Less common in Black women.
Hallmark clin symptom of endometriosis? correct answers cyclic pelvic pain beginning 1 or 2
weeks before menses, peaking 1 to 2 days before the onset of menses, and subsiding at the onset
, of flow or shortly thereafter. Other symptoms associated with endometriosis are dysmenorrhea
(often after yrs of pain-free cycles), dyspareunia, abnormal bleeding, and *infertility*.
Endometriosis is one of the most common diagnoses in the evaluation of infertility.
PE findings for endometriosis? correct answers Suble or non-existent. Do PE during early
menses when implants are largest and most-tender.
If more dissem may find uterosacral nodularity on rectovaginal exam or fixed retroverted uterus.
endometrioma PE finding? correct answers fixed adenexal mass
Diagnosing endometriosis? correct answers The only way to definitively diagnose endometriosis
is through direct visualization with laparoscopy or laparotomy.
What's a chocolate cyst? correct answers The ovary itself can develop large cystic collections of
endometriosis filled with thick, dark, old blood known as endometriomas or chocolate cysts
Not necessary correct answers Peritoneal biopsy is not necessary but is helpful in histologically
confirming the diagnosis of endometriosis.
DDX for endometriosis correct answers The differential diagnosis for endometriosis includes
other processes that result in recurrent pelvic pain such as pelvic
inflammatory disease, recurrent acute
salpingitis, adenomyosis, fibroids, adhesions, hemorrhagic corpus luteum cysts, ectopic
pregnancy, and ovarian neoplasms
American Society for Reproductive Medicine Revised
Classification of Endometriosis correct answers ...
How is endometriosis treated? correct answers Expectant Management if minimal symptoms of
it pt trying to conceive.
Medical management = temporizing measures 2/2 recurrence = suppression/atrophy of
endometrial tissue = *NSAIDs, OCPs, Progestins"
If pt trying to conceive? correct answers No role for medical management. Medical management
does not
improve conception rates and only serves to delay attempts at conception and/or employment of
surgical treatments that have
been shown to improve conception rates.
What progestin is used in med management? correct answers medroxyprogesterone i.e.
megestrol i.e. Megace
How do the medical treatments work? correct answers Induce state of pseudopregnancy. by
suppressing both ovulation and menstruation and by decidualizing the endometrial
Solutions.
What's endometriosis? correct answers Endometriosis is the presence of endometrial tissue
(glands and stroma) outside the endometrial cavity.
Most common sites? correct answers Endometrial tissue can be found anywhere in the body, but
the most common sites are the ovary and the pelvic peritoneum. Other common sites are in the
most dependent parts of the
pelvis including the uterosacral ligaments, the anterior and posterior cul-de-sacs, and the
posterior uterus and broad ligaments. Although not commonly found, endometriosis has been
identified in the lung and brain.
What's an endometrioma? correct answers Endometriosis in the ovary.
How do endometrial implants cause symptoms? correct answers by disrupting normal tissue,
forming adhesions and fibrosis, and causing severe inflammation.
Does the severity of symptoms correlate with the amount of endometriosis? correct answers No.
Women with widely disseminated endometriosis or a large endometrioma may experience little
pain, whereas women with
minimal disease in the cul-de-sac may suffer severe pain.
Three main theories regarding etiology of endometriosis? correct answers (1) Halban theory:
endometrial tissue *transported via the lymphatic system* to various sites in the pelvis, where it
grows ectopically.
(2) Meyer: multipotential cells in peritoneal tissue undergo *metaplastic transformation* into
functional endometrial tissue.
(3) Sampson suggests that endometrial tissue is transported through the fallopian tubes during
*retrograde menstruation*
Incidence of endometriosis? correct answers 10-15%
Age group? correct answers It is found almost exclusively in women of
reproductive age, and is the single most common reason for hospitalization of women in this age
group. Approximately 20% of women with chronic pelvic pain and 30% to 40% of women with
infertility have endometriosis.
Risk factors for endometriosis correct answers Women with *first-degree relatives* (mother or
sisters) with endometriosis are seven times more likely to develop the disorder than women
without this risk factor. A relationship has also been demonstrated between endometriosis and
some *autoimmune disorders (e.g., lupus).* Less common in Black women.
Hallmark clin symptom of endometriosis? correct answers cyclic pelvic pain beginning 1 or 2
weeks before menses, peaking 1 to 2 days before the onset of menses, and subsiding at the onset
, of flow or shortly thereafter. Other symptoms associated with endometriosis are dysmenorrhea
(often after yrs of pain-free cycles), dyspareunia, abnormal bleeding, and *infertility*.
Endometriosis is one of the most common diagnoses in the evaluation of infertility.
PE findings for endometriosis? correct answers Suble or non-existent. Do PE during early
menses when implants are largest and most-tender.
If more dissem may find uterosacral nodularity on rectovaginal exam or fixed retroverted uterus.
endometrioma PE finding? correct answers fixed adenexal mass
Diagnosing endometriosis? correct answers The only way to definitively diagnose endometriosis
is through direct visualization with laparoscopy or laparotomy.
What's a chocolate cyst? correct answers The ovary itself can develop large cystic collections of
endometriosis filled with thick, dark, old blood known as endometriomas or chocolate cysts
Not necessary correct answers Peritoneal biopsy is not necessary but is helpful in histologically
confirming the diagnosis of endometriosis.
DDX for endometriosis correct answers The differential diagnosis for endometriosis includes
other processes that result in recurrent pelvic pain such as pelvic
inflammatory disease, recurrent acute
salpingitis, adenomyosis, fibroids, adhesions, hemorrhagic corpus luteum cysts, ectopic
pregnancy, and ovarian neoplasms
American Society for Reproductive Medicine Revised
Classification of Endometriosis correct answers ...
How is endometriosis treated? correct answers Expectant Management if minimal symptoms of
it pt trying to conceive.
Medical management = temporizing measures 2/2 recurrence = suppression/atrophy of
endometrial tissue = *NSAIDs, OCPs, Progestins"
If pt trying to conceive? correct answers No role for medical management. Medical management
does not
improve conception rates and only serves to delay attempts at conception and/or employment of
surgical treatments that have
been shown to improve conception rates.
What progestin is used in med management? correct answers medroxyprogesterone i.e.
megestrol i.e. Megace
How do the medical treatments work? correct answers Induce state of pseudopregnancy. by
suppressing both ovulation and menstruation and by decidualizing the endometrial
