Term
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Definition
Ectopic (outside the uterus) endometrial glands and stroma
Mean age of 25-35. May give women pelvic pain, infertility
- Peritoneal - on pelvic peritoneum and ovaries
- Rectovaginal - endometriotic + adipose and fibromuscular tissue between the rectum and the vagina
** may migrate as far as the pericardium or diaphragm |
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Term
| How does endometriosis happen? |
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Definition
- Retrograde menstruation - passes backwards through fallopian tubes to peritoneum.
- Coelomic metaplasia - differentiation into endometrial tissue
** high ESTROGEN, high prostaglandins, progesterone RESISTANCE |
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Term
| What does the endometrium look like in disease-free versus a woman with endometriosis? |
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Definition
- Disease-free - low COX2, no aromatase, normal conversion to estrone
- Disease - COX2 upregulation --> more prostaglandins. Aromatase upregulation --> more estrogen. Less conversion to estrone.
** increased estradiol is responsible for survival of tissue outside the uterus. |
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Term
| What are the risk factors of endometriosis? |
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Definition
- Obstruction of menstrual flow
- Prolonged exposure to estrogen - obesity
- Short menstrual cycle
- Low birth weight, genetics
** Protective: OCs, exercise, menopause |
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Term
| What is the clinical presentation of endometriosis? |
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Definition
- Chronic pelvic pain - inflammatory cytokines, irritation of nerves
- Infertility - distorted anatomy |
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Term
| How is endometriosis diagnosed? |
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Definition
- Gold standard - laproscopy
- MRI used for endometriomas
- Staging system I to IV |
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Term
| How is pelvic pain treated in endometriosis? |
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Definition
| - Pelvic pain - can do surgery, but 30-60% recurrence. Drug therapy: NSAIDs, OCs, progestins. NSAIDs first option, but not long term. Continuous dosing OCs to promote LH inhibition and decidualization. Progestin-only therapy. |
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Term
| How are GnRH agonists used for endometriosis? |
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Definition
Continuous doses downregulates receptors for LH/FSH. Induction of hypogonadal state resembling post-menopause
- Leuprolide, Goserelin, Nafarelin. Initial flare, then decr. Regularly assess BMD.
- Start with progestin --> GnRH agonism
- Add-back therapy: add back estrogen/progesterone with GnRH agonist therapy >6 months. Premarin + medroxyprogesterone/NET |
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Term
| Why was danazol used for endometriosis? |
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Definition
| Suppressed HPA axis. Severe androgenic effects - weight gain, cramps, acne. No longer used. |
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Term
| How are aromatase inhibitors used for endometriosis? |
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Definition
Lowers estradiol levels, must take with OCs in pre-menopausal women.
- Letrozole or Anastrazole |
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Term
| What treatment is available for infertility associated with endometriosis? |
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Definition
- Surgical therapy
- Assistance such as IVF |
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