Endometriosis
INTRODUCTION:
- Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus , the endometrium , grows outside your uterus.
- Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis.
- Rarely, endometrial tissue may spread beyond pelvic organs.
- Theories for explaining endometriosis:
- Sampson’s Implantation theory
- Metastatic epithelium
- Histogenesis by induction and Coelomic metaplasia theory both
ETIOLOGY:
- Retrograde menstruation
- Transformation of peritoneal cells
- Embryonic cell transformation
- Surgical scar implantation
- Endometrial cells transport.
- Immune system disorder.
RISK FACTORS:
- Never giving birth
- Starting your period at an early age
- Going through menopause at an older age
- Short menstrual cycles — for instance, less than 27 days
- Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
- Low body mass index
- Alcohol consumption
- One or more relatives (mother, aunt or sister) with endometriosis
- Any medical condition that prevents the normal passage of menstrual flow out of the body
- Uterine abnormalities
SYMPTOMS:
Common signs and symptoms of endometriosis may include:
- Age group – 30 – 40 years
- Most common in nulliparous females
- Ovary is the most common site 30-40% of cases
- Broad ligament (except tubes and ovaries) most common extrauterine site to be affected by endometriosis
- Hormone dependent condition
- The severity of pelvic pain in endometriosis correlates best with Depth of invasion
- Can involve lung pleura
- Premenstrual spotting is seen in Endometriosis
- True cyst: B/L chocolate cyst of ovary
- Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain.
- Pain with intercourse. Pain during or after sex is common with endometriosis.
- Pain in endometriosis correlates with depth.
- Pain with bowel movements or urination. You’re most likely to experience these symptoms during your period.
- Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
- Infertility: Immobility of tubes,Anovulation & Tubal block are causes of infertility
- Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.
COMPLICATIONS:
- Infertility :The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.
- Ectopic pregnancy
- Retroverted uterus is Associated with endometriosis
- Ovarian cancer: Ovarian cancer does occur at higher than expected rates in women with endometriosis.
- Uterine fibromyoma
- Scar endometriosis:Endometriosis sometimes occurs in abdominal wall scars following operations
- Hysterotomy ( surgery of choice for diffuse endometriosis interna)
- Classical cesarean section
- Myomectomy
- Ventrofixation
- Following operations for section of Fallopian tube
- Following operations for removal of pelvic
- Episiotomy
- Endometriosis
DIAGNOSIS:
- Pelvic exam
- Ultrasound
- Laparoscopy:Pawaer burr,Diagnostic laparoscopy is the gold standard for diagnosing endometriosis.
- CA 125 is elevated in Endometriosis
TREATMENT:
- Pain medications: (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others)
- Hormone therapy: Hormonal contraceptives, Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, Progestin therapy(at young age), Danazol, Medroxy progesterone(DOC)
- Conservative surgery
- Treatment of endometriosis in an infertile female Clomiphene
- Assisted reproductive technologies, such as in vitro fertilization
- Hysterectomy:In severe cases of endometriosis, surgery to remove the uterus and cervix (total hysterectomy) as well as both ovaries may be the best treatment.
- Trans-Cervical Endometrial Resection (TCER) is used in Endometriosis
Exam Question
- Infertility is seen in Endometriosis
- Uterine fibromyoma is associated with Endometriosis
- Endometriosis is MC in 3rd or 4th decade
- Premenstrual spotting is seen in Endometriosis
- True cyst is seen in Endometriosis
- Endometriosis is Hormone dependent condition
- Endometriosis Can involve lung pleura
- Ovary is the most common site in Endometriosis
- Endometriosis is commonly associated with B/L chocolate cyst of ovary
- Pain in endometriosis correlates with Depth
- Best investigation to establish the diagnosis of endometriosis is Laparoscopy
- Medroxyprogesterone acetate,Progesterone,GnRH, OCP & Danazol are used in treatment of endometriosis
- Scar endometriosis can occur in Classical Cesarean Section, Hysterotomy & Episiotomy
- Treatment of a cause of Endometriosis at a younger age group Progestin
- Endometriosis is explained by Sarnpson’s Implantation theory & Histogenesis by induction and Coelomic metaplasia theory both
- Endometriosis shows Metastatic epithelium
- Endometriosis is painful
- Commonest manifestation of endometriosis is pain
- Endometriosis mostly occurs in Nulliparous women
- The surgery of choice for diffuse endometriosis interna is Total hysterectomy
- Medroxy progesterone is the drug of choice to treat endometriosis
- Broad ligament (except tubes and ovaries) is the most common extrauterine site to be affected by endometriosis
- In the etiology of endometriosis Sampson’s theory is Implantation theory
- The severity of pelvic pain in endometriosis correlates best with Depth of invasion
- Treatment of endometriosis in an infertile female Clomiphene
- Cause of unilateral dysmenorrhea is Endometriosis with unilateral distribution
- CA 125 is elevated in Endometriosis
- Trans-Cervical Endometrial Resection (TCER) is used in Endometriosis
- Retroverted uterus is Associated with endometriosis
- The condition of genital organs whlch may lead to leslons in surgicalscars, rectum, lymph nodes, lung ls endometriosis
- Pawaer burr, appearance on laparoscopy is characteristic of endometriosis
- Ectopic pregnancy is common in endometriosis
- Most common symptom of endometriosis is Dysmenorrhoea
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