OB/GYN --- Endometriosis & Adenomyosis

How do you Dx endometriosis?

= Direct visualization ("powder burns", "mulberry or raspberry" lesions, chocolate cysts=endometiomas) or Peritoneal biopsy

What is the tx of adenomyosis?

= Hysterectomy is definitive treatment

What are the PE findings of adenomyosis?

diffusely mildly enlarged, globular uterus (boggy looking, ~12wk size)

What is the cause of sx of endometriosis?

disruption of normal tissue (fibrosis and adhesions), severe inflammation, o Severity of physical findings does NOT correlate with severity of symptoms

What is the MOST common reason for hospitalization of women in reproductive age group?

endometiosis

What is adenomyosis?

endometrial tissue in the myometrium of the uterus

What does the PE findings of endometriosis ?

no physical findings, uterosacral nodularity, retroflexed - fixed uterus, May have adnexal tenderness or mass if an endometrioma is present

What are the most common sites of endometriosis?

ovary (endometrioma) and pelvic peritoneum

How do you dx adenomyosis?

pathology report

What is endometriosis?

presence of endometrial tissue outside the endometrial cavity - can be anywhere in the body

What is the cause of adenomyosis?

unknown

What is the menagement of adenomyosis?

Menorrhagia @ age >35yrs -do endometrial biopsy to r/o cancer, NSAIDs, contraceptives

What is the Tx of endometriosis?

Depends on extent of disease & desire for fertility o Expectant = wait and see o Medical goals = pain control and suppression & atrophy of endometrial tissue NSAIDs, Hormonal contraceptives or GnRH agonists o Surgical = ablation or excision of implants. Hysterectomy with bilateral salpingooophorectomy, lysis of adhesions and removal of implants