Endometriosis

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Endometriosis

~ Endometriosis ~

y Etiology

§ Three Theories of Pathogenesis:

Transplantation Theory
Coelomic Metaplasia
Induction Theory

§ Genetic Factors:

The risk of endometriosis is 7 times greater if a first-degree relative has been affected by endometriosis.
multifactorial inheritance

§ Immunologic Factors:

The immune system may be altered in women with endometriosis, and the disease may develop as a result of reduced immunologic clearance of viable endometrial cells from the pelvic cavity.

y Prevalence

y Diagnosis

§ Clinical Presentation:

Pain:

? Dysmenorrhea: often bilateral, starting before onset of menstruation bleeding and lasting

throughout the period

- adults: after years of pain-free menses,

- adolescents: may without an interval of pain-free menses after manarche.

‚ Local Symptoms: (arising from rectal, ureteral, bladder, and other area involvement)

- dyspareunia, chronic pelvic pain, lower back pain, etc.

« Most studies have failed to detect a correlation between the degree of pelvic pain and the

severity of endometriosis.

Subfertility:

? Infertility:

‚ Spontaneous Abortion:

« Subfertility is associated with moderate and severe endometriosis, however, the

association between subfertility and minimal or mild endometriosis remains controversial.

Endocrinologic Abnormalities:

Anovulation, abnormal follicular development, luteal insufficiency, premenstrual spotting, galactorrhea, hyperprolactinemia, etc.

Extrapelvic Endometriosis:

Extrapelvic endometriosis, although often asymptomatic, should be suspected when symptoms of pain or a palpable mass occur outside the pelvis in a cyclic pattern.

Asymptomatic

§ Clinical Examination:

nodularity, painful swelling, fixed RVF uterus, reduced mobility of adnexa, unilateral ovarian enlargement, etc.

§ CA125

§ Laparoscopic Findings:

Histological Confirmation of the laparoscopic impression is essential for the diagnosis of endometriosis.

§ Histological Confirmation:

§ Classification:

Revised American Fertility Society Classification
Figure 26.5, p897.

y Spontaneous Evolution

An estrogen-dependent disease
A progressive disease

y Treatment

§ Surgical Treatment:

Laparoscopy:

- able to be used in most women

Laparotomy:

reserved for patients with advanced stage disease and for those in whom fertility conservation is no longer necessary.

« goal of the surgery:

? to excise or coagulate all visible endometriotic lesions and associated adhesions

‚ to restore normal anatomy

ƒ for endometrioma:

< 3 cm Þ aspiration, then destroy the mucosal lining of the cyst

> 3 cm Þ aspiration, then remove the cyst wall from the normal ovarian cortex

§ Medical Treatment:

Oral Contraceptives:

Progestins: the first choice for the treatment

Gestrinone:

Danazol:

GnRH Agonist:

« Progestin, danazol, gestrinone, or GnRH agonists are effective for pain associated with

endometriosis.

« Conception is either impossible or contraindicated during medical treatment of endometriosis.

§ Prevention of Infertility:

minimal to mild diseases

mild diseases:

surgical removal of endometriotic lesions, followed by cyclic low-dose oral contraceptive to prevent recurrence

advanced diseases:

6-month medical treatment, followed by cyclic or continuous oral contraceptives to prevent progression

§ Assisted Reproductive Technology: IVF with IUI or GIFT

Filename: Endometriosis