Chapter 15 Endometriosis and adenomyosis

What are adenomyomas

A well-circumscribed collection of endometrial tissue within the uterine wall. They may also contain smooth muscle cells and are not encapsulated (vs fibroids). Adenomyomas can also prolapse into the endometrial cavity similar to a classic endometrial polyp.

changes in uterus with adenomyosis

Adenomyosis causes the uterus to become diffusely en- larged and globular due to hypertrophy and hyperplasia of the myometrium adjacent to the ectopic endometrial tissue.

What is adenomyosis? PE? treatment

An extension of endometrial tissue into the uterine myometrium leading to abnormal bleeding and pain. The uterus becomes soft, globular. Progestin-containing IUD and hysterectomy are the most effective means of treatment.

US findings of endometrioma

Note the characteristic "ground glass" appearance of the endometrioma on ultrasound.

risk factors for endometriosis

Nulliparity, early menarche, prolonged menses, and müllerian anomalies are associated with an increased risk of diagno- sis with endometriosis and autoim- mune inflammatory disorders such as lupus, asthma, hypothy- roidism, chronic fatigue syndrome, fibromyalgia, and allergies.

What is endometriosis? how is it treated

The presence of endometrial cells outside the uterine cavity. The hallmark of this chronic disease is cyclic pelvic pain. These estrogen-sensitive lesions can be treated with NSAIDs, OCPs, progestins, GnRH agonists, or surgery.

appearance of endometriosis

They may appear as rust-colored to dark brown powder burns or raised, blue-colored mulberry or raspberry lesions.

Pain presentation of endometriosis

cyclic pelvic pain beginning 1 or 2 weeks before menses, peaking 1 to 2 days before the onset of menses, and subsiding at the onset of menses or shortly thereafter.

pe findings of adenomyosis. Size of uterus in adenomysosis. Contrast the texture of the uterus in adenomysosis vs in fibroids

diffusely enlarged globular uterus. The uterus is usu- ally less than 14 cm. The consistency of the uterus is typically softer and boggier than the firmer, rubbery uterus containing fibroids

Other symptoms of endometriosis

dysmenorrhea, dyspareunia, abnormal bleeding, bowel and bladder symptoms, and subfertility.

does the severity of symptoms correlate with the amount of endometriosis

no

treatment of a female with endometriosis who is trying to conceive

none There is no role for medical management in patients attempt- ing to conceive.

Possible side effects of danazol

patients may experience some androgen-related, anabolic side effects including acne, oily skin, weight gain, edema, hirsutism, and deepen- ing of the voice.

What is another possible treatment of endometriosis

reversible state of pseudomenopause with the use of danazol (Danocrine), an androgen derivative, or gonadotropin-releasing hormone (GnRH) agonists such as leuprolide acetate (Lupron) and nafarelin (Synarel). classes of drugs suppress follicle-stimulating hormone (FSH) and luteinizing hormone (LH). As a result, the ovaries do not produce estrogen, resulting in decreased stimulation of endometrial implants

sx of adenomyosis

secondary dysmenorrhea (may begin up to 1 week before menses and last until cessa- tion of bleeding.) (30%), menorrhagia

Physical exam findings of endometriosis

usually none. but are nonspecific (nodularity, tenderness, fixed adnexal mass when ovary is involved)

age at which women have symptoms associated with adenomyosis

women between age 35 and 50.

what is an endometrioma

Endometriosis in the ovary appears as a cystic collection known as an endometrioma.

Possible side effects of lupron

GnRH agonists such as Lupron result in estrogen deficiency. The side effects of these medications are similar to those seen during menopause including hot flashes, decreased bone density, headaches, and vaginal atrophy and dryness. To prevent these GnRH agonists are combined with a small amount of progestin and/or estrogen to minimize these effects

treatment of adenomyosis

Hysterectomy is the only definitive treatment for adeno- myosis. NSAIDs), cyclic or continuous estrogen-progestin contraceptives (pills, patches, rings) and menstrual suppression with progestins (oral, injectable, or intrauterine) have also been found to be temporarily helpful. Short-term relief has also been achieved using endometrial ablation; however, pain and bleeding recur more frequently when adenomyosis is involved. The levonorgetrel-containing IUD has been found to be the most effective temporary means of managing the symptoms of adenomyosis.

age range of endometriosis

It is found almost exclusively in women of repro- ductive age

What is a leiomyoma?

Local proliferations of smooth muscle cells within the myometrium, often surrounded by a pseudocapsule. Also known as fibroids, these benign growths may be located on the intramural, subserosal, or submucosal portion of the uterus.

treatment options for endometriosis in patients not trying to conceive

NSAIDs, cyclic or continuous estrogen-progestin contraceptives (pills, patches, rings), and menstrual suppression with progestins (oral, injectable, or intrauterine). induce a state of " pseudopregnancy" by suppressing both ovulation and menstruation

contrast the changes that occur during menstrual cycle in endometriosis vs adenomyosis. what effects does this have on treatment options?

Because the endometrial tissue in adenomyosis extends from the basalis layer of the endometrium, it does not undergo the proliferative and secretory changes traditionally seen in normally located endometrium or in endometriosis. adenomyosis is less responsive to treatment with OCPs or other hormonal treatments