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Endometriosis

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Topic updated on 07/17/16 6:05am

Snap Shot
  • A 29-year-old nulligravida complains of severe pain with menses and inability to conceive after 24 months of unprotected intercourse. She says she feels pain with defecation and intercourse. On pelvic exam, her uterus is found to be retroverted and there is nodularity of the uterosacral ligament on retrovaginal examination.
Introduction
  • A benign condition where the endometrial glands and stroma are located outside of the uterus
    • most commonly a result of reverse menstrual flow into fallopian tubes
  • Occurs in early reproductive years (less than age 35)
  • Most common sites
    • ovaries
    • rectal pouch of Douglas
    • uterosacral ligaments
    • broad ligament
    • oviducts
Presentation
  • Symptoms
    • dysmenorrhea
    • dyspareunia (painful intercourse)
    • dyschezia (painful defecation) during menses
    • infertility
    • chronic pelvic pain
Evaluation
  • Laparoscopic examination with biopsy
    • blood-filled ("chocolate") cysts
    • diffuse involvement of peritoneal surfaces with thickened, scarred, "powder burn" implants
  • CA-125 serology
    • high sensitivity but low specificity
      • good in endometriosis exclusion
Treatment
  • Pharmacologic
    • progestins
    • OCPs
    • GnRH agonist
      • inhibits ovarian function and leads to hypoestrogen state
  • Operative
    • laparoscopic ablation
    • total abdominal hysterectomy 
Complications
  • Infertility
  • Ectopic pregnancy


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