ENDOMETRIOSIS

PENDAHULUAN
Endometriosis kelenjar dan struma endometrium diluar uterus,
jinak bersifat progresif dan menginvasi secara lokal.

First identified in the mid-nineteenth century (Von Rokitansky, 1860),

Exact prevalence is unknow, population based study 6,2 %

10-20% wanita menstruasi

20% operasi di bidang ginekologi
 PATOFISIOLOGY
ETIOLOGY
the definitive cause of endometriosis
remains unknown, several theories with
supporting evidence have been described

Teori retrogade menstrusi (Sampson, 1927)

Teori genetik dan imunologik

Teori hormonal

Teori metaplasia soelemik

Teori transplantasi langsung

Estrogen dependent
RISK FACTOR

FAMILIAL CLUSTERING

GENETIC MUTATION

ANATOMIC DEFECT

ENVIRONMENTAL
TOXINS
 DIAGNOSIS
KELUHAN UTAMA
PAIN
DYSMENORRHEA
DYSPAREUNIA
DYSURIA
DEFECATORY
PAIN
INTESTINAL
OBSTRUCTION
PEMERIKSAAN

Visual inspection
- Sering tidak ada
gambaran khas
- Warna kecoklatan di
tempat bekas irisan SC
atau episiotomi

Spekulum
bluish or red powder-
burn lesions tender or
bleed with contact
PEMERIKSAAN

Bimanual Examination
Uterus retrovert,
fix, lunak
Nodul ligament utero
sakral, lunak
Adnexa mass
enlarged
endometrioma
Differential diagnosa
 Laboratory
Complete blood count
Urinalysis & cultures
Vaginal culture & vaginal swab

Ca 125 serum elevated CA125 levels

have been shown to positively correlate
with the severity of endometriosis Gr
ade 3-4/ endometrioma
- Sensitivity 28 %
- Spesificity 90 %

Ca19-9
 DIAGNOSTIC IMAGING
USG
MRI
Laparoskopi merupakan
pemeriksaan yg utama dan
pasti
- Prosedur minimal invasif

- Sensitivitas 97%

- Spesifitas 77%
STADIUM ENDOMETRIOSIS
 TERAPI
OBSERVASI
PALIATIF
Analgetik
NSAID
Inhibitor sintesa PG

TERAPI ENDOKRIN
Agonis GnRH
Danazol / androgen
Estrogen-progesteron (pil kontrasepsi)
Progesteron
TERAPI PEMBEDAHAN
Pembedahan konservatif
Mengurangi rasa sakit
Definitif
 PEMBEDAHAN
Konservatif fungsi reproduksi masih
ingin dipertahankan
Semikonservatif fungsi reproduksi
sudah tidak dipertahankan tetapi
fungsi ovarium masih dipertahankan
Radikal uterus dan ovarium diangkat
 MEDIKAMENTOSA
GnRH analog (agonist)
Terapi medikamentosa yg plg efektif
Kombinasi GnRH analog dgn pengobatan operatif
plg banyak dianut dan paling rendah angka
residifnya
Menimbulkan kondisi hypogonadotrophic-
hypogonadic akibat down-regulation dari
kelenjar hipofise
Leuprolide acetate (Endrolin ) merupakan GnRH
agonist yang banyak digunakan
SIDE EFFECT
Vaginal dryness,
decreased
libido, mood swings,
skin dryness,
decreased bone
density
 MEDIKAMENTOSA
Progestogen menimbulkan atrofi
endometrium
Pil kontrasepsi menekan ovarium dan
memberikan progestin scr kontinue
Androgen (Danazol ) menghambat midcycle
FSH and LH surge dan mencegah steroido-
genesis di korpus luteum
Aromatase inhibitor (Letrozole) memblok
konversi androstenedione dan testosterone
mjd estrogen