It's a Numbers Game
Prevalence in reproductive age women
10%
Name 5 symptoms
dysmenorrhea, chronic pelvic pain, dyspareunia, uterosacral ligament nodularity, adnexal masses, dyschezia, hematochezia, hematuria, dysuria
First line treatment for symptomatic endometriosis
1. NSAIDs
2. Oral contraceptives
3. Progestins
Should be trialed for 3 to 6 months
How many physicians does a woman see before endometriosis is diagnosed?
Prevalence in females presenting with infertility
50%
Common pelvic sites of implantation (in decreasing order)
ovary, anterior and posterior cul-de-sac, posterior broad ligaments, uterosacral ligaments, pouch of Douglas, bladder, uterus, fallopian tubes, sigmoid colon, appendix, round ligaments
Second line treatment
GnRh agonists
What is the most popular proposed theory behind pathogenesis?
Retrograde menstruation - endometrial cells flow backwards through the tubes and into the peritoneal cavity during menses
Patient's with a first degree relative have a ___ increased risk of developing endometriosis
7-10 fold
The definitive diagnosis can only be made by __
histology of lesions
Most definitive surgical treatment
What are two rare documented sites of involvement?
1. lining of the lungs
2. brain
Chronic pelvic pain unresponsive to treatment developed in __ of endometriosis patients
30%
Key components in the development are overproduction of __ by an increase in COX2 and overproduction of __ by aromatase activity
prostaglandins
estrogen
Size of an endometrioma that should be removed surgically
4 cm or greater
What is the effect on pregnancy?
Variable! Some patients an improvement in symptoms, though are reported cases of intestinal perforation, hemoperitoneum, acute appendicitis, and ruptured or infected ovarian endometrioma
What percent of lesions progress?
29%
3 risk factors for the development of endometriosis
1. early menarche (occurring before 11 y/o)
2. shorter cycles (<27 days)
3. heavy, prolonged cycles
Percent of women with recurrent symptoms over 5 years irrespective of treatment approach
50%
Risk of malignant transformation of endometriosis is __ for premenopausal females and __ for postmenopausal females
1%
1-2.5%