MD Hom Associate professor DEPARTMENT OF GYNAECOLOGY AND OBSTETRICS SARADA KRISHNA HOMOEOPATHIC MEDICAL COLLEGE KULASEKHARAM Endometriosis Definition Ectopic Endometrial Tissue ID: 919794
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Slide1
Endometriosis
DR. L. GIRIJA.
M.D.
(
Hom
.),
Associate professor,
DEPARTMENT OF GYNAECOLOGY AND OBSTETRICS,
SARADA KRISHNA HOMOEOPATHIC MEDICAL COLLEGE,
KULASEKHARAM
Slide2Endometriosis
Definition: Ectopic Endometrial Tissue
True Incidence Unknown: ? 1-5%
Does NOT Discriminate by Race
Histology: Endometrial Glands with Stroma +/- Inflammatory Reaction
Slide3Signs and Symptoms
Chronic Pelvic Pain, Dysmenorrhea
Abnormal Uterine Bleeding
Infertility
Deep Dyspareunia
Pelvic Mass (Endometrioma)
Misc: Tenesmus, Hematuria, LBP, Hemoptysis
Slide4Prevalence
Slide5Etiology: Theories
Sampson: “Retrograde Menstruation”
Hematologic Spread
Lymphatic Spread
Coelomic
Metaplasia
Genetic Factors
Immune FactorsCombination of the AboveNo Single Theory Explains All Cases of Endometriosis
Slide6Diagnosis
Laparoscopy (“Gold Standard)
Laparotomy
Inconclusive: CA-125, Pelvic Exam, History, Imaging Studies
Biopsy Preferable Over Visual Inspection
Slide7Appearance
Endometriosis May Appear
Brown
Black (“
Powderburn
”)
Clear (“Atypical”)
Endometriosis May Be Associated with Peritoneal Windows
Slide8Treatment: Overall Approach
Recognize Goals:
– Pain Management
– Preservation / Restoration of Fertility
Discuss with Patient:
– Disease may be Chronic and Not Curable
– Optimal Treatment Unproven or Nonexistent
Slide9Classification / Staging
Several Proposed Schemes
Revised AFS System: Most Often Used
Ranges from Stage I (Minimal) to Stage IV (Severe)
Staging Involves Location and Depth of Disease, Extent of Adhesions
Slide10Continuous OCPs
“
Pseudopregnancy
? Minimizes Retrograde Menstruation
Lower Fertility Rates than Other Medical Treatments
Choose OCPs with Least Estrogenic Effects, Maximal Androgenic / Progestin Effects
Slide11Surgical Treatment
(Laparoscopy / Laparotomy)
Excision
sí
/
Fulgeration
no! Resection of EndometriomaLysis of Adhesions, Cul-de-sac ReconstructionUterosacral Nerve AblationPresacral
NeurectomyAppendectomyUterine Suspension (? Efficacy)Hysterectomy +/- BSO
Slide12Conclusion
Endometriosis is a Common, Chronic Disease
Typical Symptoms Include Pain, Infertility, Abnormal Uterine Bleeding
The Optimal Treatment Remains Unclear
Surgical Excision is the Most Efficacious Approach with Respect to Fertility
Better Medical Therapies are Needed