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Endometriosis &

Adenomyosis
dr. Selly Septina, SpOG

Description of Endometriosis
• presence of endometrial tissue, composed
of glands and stroma, at sites outside
endometrial cavity
• most common sites
– ovary
– broad ligament
– cul-de-sac
– rectovaginal septum

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• endometrial tissue responds cyclically to estrogen – swelling – producing local inflammation • severity of pain unrelated to extent of disease – There may be more pain associated with active lesions in mild disease than with adhesions in severe disease • commonly occurs in women in 20’s and 30’s – tends not to occur before menarche or after menopause • major cause of infertility .

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such as repeated inflammation • Hematogenous spread .Theories for Etiology • Sampson’s theory of retrograde menstruation • Halban’s lymphatic spread theory • Meyer’s mullerian metaplasia theory – metaplasia of mesothelial cells into endometrial epithelium under some unidentified influence.

Epidemiology • found equally among all races • more likely to occur and progress in women with – early menarche – in those with menstrual flow exceeding seven days – cycles of less than 27 days – years of menstruation uninterrupted by pregnancy – family history of endometriosis .

Incidence • 10-15 % of women of reproductive age • 40-50 % of women undergoing surgery for evaluation of infertility • average age at diagnosis is 28 .

History • most common symptoms – dysmenorrhea – dyspareunia (especially on deep penetration) – perimenstrual back pain – infertility .

especially premenstrual spotting • less common symptoms – urgency in urination – hematuria – rectal bleeding .• other symptoms reported – abdominal pain – irregular bleeding patterns.

Physical Exam Findings • may appear normal if lesions = small & few • advanced disease – cervical displacement of 1 cm or more to the left or right of midline – bimanual exam tenderness and nodularity of the uterosacral ligaments and posterior cul-de-sac are detected – adnexal masses that vary in size. fixed. cystic. and consistency and may be asymmetric. or indurated – fixed retroversion of the uterus . shape.

chocolate cystic mass .Endometriosis on /in the Ovary • Forms a dark.

Diagnostic Tests • CA-125 elevated • CBC normal • Diagnostic laparoscopy http://medstat.html .edu/kw/human_repr od/mml/hr08.utah.med.

Differential Diagnoses • • • • • • chronic PID recurrent acute salpingitis hemorrhagic corpus luteum benign or malignant ovarian neoplasm ectopic pregnancy adenomyosis .

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Treatment Plan • psychosocial intervention • medications – danazol – progestogens – combined Ocs – gonadotropin-releasing hormone agonists (GnRH-a) • Lupron injection qmo x 6 mos • Synarel nasal spray bid x 6 mos • surgical interventions: conservative vs. definitive .

GnRH analogs • Decreases secretion of gonadotropins • Major concerns are… – Cost – Parenteral administration – Potential for accelerated bone mineral loss – Hot flashes & hypo-estrogen states .

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Adenomyosis • Growth of the glands & stroma within the myometrium (muscle wall) • Affects the parous women over 40 y/o • Etiology .downward growth of surface endometrium .

uterus on exam : if menstruating. boggy. uterus may be board-like! .Adenomyosis . tender.S &S • Dysmenorrhea • Menorrhagia • Bulky.

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Treatment of Adenomyosis • Medical therapy used to treat endometriosis does not help! • Abdominal Hysterectomy • Will cease after menopause .

Thank You .