29 Jul Endometriosis

• Extremely common among women of childbearing age.
• Pelvic inflammation and fibrosis: can lead to infertility.
• Normal endometrial stromal cells in other areas of the pelvis and abdomen other than the inside of the
uterus.
• Causes chronic pelvic pain, particularly with menses, and decreased fertility.
• If the first-degree relative with endometriosis: a greater chance of having the disease.
• Dyspareunia, pelvic pain, low back/low abdominal pain, irregular, heavy, painful menses. Pain on defecation
(dyschezia): endometriomas on the rectum or anal area.
• Pregnancy and menopause: decrease the symptoms and can cure the disease.
• Using HRT after menopause will bring the disease back.
• Acute abdominal pain if endometrioma ruptures, leading to bleeding in the abdomen.
• Etiology isn’t clear.
• Laparoscopy is the best way to make the diagnosis of endometriosis.
• Hormonal interference can manage this disorder without having to do surgery.
• Drugs most often used include combining oral contraceptive pills, Danazol (which has androgenic
properties), progestin-containing drugs (which prevent proliferation), and gonadotropin-releasing hormone
(GnRH) analogue.
• Surgical care if medical treatments fail and the patient is symptomatic.
• Conservative surgery to remove adhesions and endometriomas only when a woman still desires to be pregnant
can be successful in reducing symptoms and restoring fertility.
• Semiconservative surgery involves removal of the endometriomas and the uterus with retention of the
ovaries.
• Radical surgery involves removal of the uterus, ovaries, and any endometriomas found in the pelvic cavity.
• Prognosis of endometriosis: About a third of women: spontaneous resolution of their disease state, even
without treatment
• About 95 per cent will respond to medical treatment.
• The downside of medical therapy: Often doesn’t restore fertility.
• Infertility mainly structural and related to the ovaries being physically unable to release an egg.