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Title:

Endometriosis

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Endometriosis * Discuss infertility: uncertainty in mild disease, surgery for moderate disease, and IVF for severe problems and after a previous surgery, medical ... – PowerPoint PPT presentation

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Title: Endometriosis


1
Endometriosis
2
Incidence
  • 6-10 of reproductive age women
  • Present in up to 75 of patients with chronic
    pelvic pain
  • Present in 40 of women with infertility
  • FH of 1st degree relative increases risk 10 fold
  • Etiology

3
Manifestations
  • Dysmenorrhea
  • Chronic pelvic pain
  • Dysparunia
  • Uterosacral nodularity
  • Adenexal mass
  • Infertility

4
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5
Diagnosis
  • Laparoscopy is only definite diagnostic test
  • Confirmed 80 of the time if clinically suspected
  • Appropriate to treat with only a clinical
    diagnosis

6
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7
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8
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9
Surgical Treatment
  • Hysterectomy with BSO has a failure rate of 5
  • Hysterectomy w/o BSO has a 2/3 recurrence rate
    and 1/3 rate of repeat surgery
  • Laparoscopic conservative surgery shows 60
    improvement in pain and 40recurrence with in 2
    years
  • Not clear if fertility improved by surgery

10
Medical Treatment
  • First line is OCPs either cyclic or continuous
    with or without NSAIDS
  • Second line is
  • Depo Provera 150mg x 3 mon
  • GNRH agonists with or with out add back
  • Danazol 400-600mg/d x 3-6 mon

11
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12
GNRH agonists
  • Leuproline (Lupron) IM 3.75-7.5mg/m or 11.25mg/3m
    for 3-6 month

13
Add Back Therapy
  • Purpose is relieve hotflashes and limit bone loss
  • Start after 0-3 months of GNRH agonist therapy
  • No difference in effectiveness of treatment for
    endometriosis
  • Use any form of HRT (estrogen progestin) in
    lowest dose to control hotflashes

14
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15
Treatment Flow Sheet
16
Miscellaneous Topics
  • Value of treatment in improving fertility in mild
    disease is not established
  • Combination surgery followed by medical therapy
    (OCP or Depoprovera) results in best pain relief
  • Ovarian endometriomas should be managed
    surgically
  • Mirena, continuous OCP, Depoprovera

17
  • 48 y/o s/p TAH for fibroids
  • CC RLQ pain sudden onset 8 out of 10
  • PI Present to ER with severe pain w/o fever,
    chills, nausea or vomiting, no constipation or
    diarrhea

18
  • VS P110, BP 135/85, afebrile
  • Abdomen diffusely tender especially in the RLQ,
    with mild rebound
  • Pelvic exam Cx, uterus absent, bimanual bulging
    tender firm mass felt vaginally

19
  • CBC Hb 12.5, WBC 11,000 normal diff
  • CMP normal, UA normal
  • CT 9.5x6.7 cm multicystic right ovarian lesion,
    small amount of nonspecific pelvic fluid,
    appendix normal

20
  • Returned a few hours later still in pain
  • WBC 14,000 with left shift
  • Sent to U of I ER/Gyn department

21
  • U of I ER/gyn saw her, did tumor markers, and
    released her
  • Ultrasound in my office 9.5x5.5 complex,
    ?hemorrhagic cystic mass with no blood flow
  • Consulted with U of I gyn who said tumor markers
    were negative

22
  • U of I did 23 hr stay releasing her on BCP, po
    dilaudid, and follow up in 2 weeks
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