Endometriosis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Classic symptoms: dysmenorrhea, pelvic pain, dyspareunia, and infertility | *Classic symptoms: dysmenorrhea, [[pelvic pain]], dyspareunia, and infertility | ||
*Mnemonic: 3 D's--dysmenorrhea, dyschezia and dyspareunia | *Mnemonic: 3 D's--dysmenorrhea, dyschezia and dyspareunia | ||
*Other symptoms may include: include abnormal uterine bleeding, low back pain, or chronic fatigue | *Other symptoms may include: include abnormal [[vaginal Bleeding Non-Pregnant|uterine bleeding]], low [[back pain]], or chronic fatigue | ||
*Endometriosis is commonly detected as an asymptomatic incidental finding on pelvic ultrasound or during a surgical procedure | *Endometriosis is commonly detected as an asymptomatic incidental finding on pelvic ultrasound or during a surgical procedure | ||
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*Pelvic adhesions | *Pelvic adhesions | ||
*[[Irritable bowel syndrome]] | *[[Irritable bowel syndrome]] | ||
*Colon cancer | *[[Colon cancer]] | ||
*[[Diverticulitis|Diverticular disease]] | *[[Diverticulitis|Diverticular disease]] | ||
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*Exam with tenderness when palpating posterior fornix | *Exam with tenderness when palpating posterior fornix | ||
*Labs are not generally useful | *Labs are not generally useful | ||
*Pelvic ultrasound is the first-line study | *[[Pelvic ultrasound]] is the first-line study | ||
*Laparoscopy for definitive diagnosis | *Laparoscopy for definitive diagnosis | ||
==Management== | ==Management== | ||
*Symptomatic management | *Symptomatic management | ||
*Analgesia | *[[Analgesia]] | ||
*Hormonal medical therapy | *Hormonal medical therapy | ||
**OCP's, GnRH agonists, progestins, danazol, aromatase inhibitors | **OCP's, GnRH agonists, progestins, danazol, aromatase inhibitors | ||
Revision as of 17:38, 24 September 2019
Background
- Endometrial glands and stroma at extrauterine sites, generally in the pelvis but can be anywhere in the body
- The condition is a common, benign, estrogen-dependent disorder
- Can be associated with debilitating symptoms
Clinical Features
- Classic symptoms: dysmenorrhea, pelvic pain, dyspareunia, and infertility
- Mnemonic: 3 D's--dysmenorrhea, dyschezia and dyspareunia
- Other symptoms may include: include abnormal uterine bleeding, low back pain, or chronic fatigue
- Endometriosis is commonly detected as an asymptomatic incidental finding on pelvic ultrasound or during a surgical procedure
Differential Diagnosis
- Ectopic pregnancy
- Pelvic inflammatory disease
- Interstitial cystitis
- Adenomyosis
- Ovarian neoplasms
- Pelvic adhesions
- Irritable bowel syndrome
- Colon cancer
- Diverticular disease
Nonpregnant Vaginal Bleeding
Systemic Causes
- Cirrhosis
- Coagulopathy (Von Willebrand disease, ITP)
- Group A strep vaginitis (prepubertal girls)
- Hormone replacement therapy
- Anticoagulants
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Hypothyroidism
- Polycystic Ovary Syndrome
- Secondary anovulation
Reproductive Tract Causes
- Adenomyosis
- Atrophic endometrium
- Dysfunctional uterine bleeding
- Endometriosis
- Leiomyoma (Fibroid)
- Foreign Body
- Infection (vaginitis, PID)
- IUD
- Neoplasia (especially in women >45 years old or in younger women with other risk factors)
- Vaginal Trauma
Evaluation
- History of symptoms described above
- Exam with tenderness when palpating posterior fornix
- Labs are not generally useful
- Pelvic ultrasound is the first-line study
- Laparoscopy for definitive diagnosis
Management
- Symptomatic management
- Analgesia
- Hormonal medical therapy
- OCP's, GnRH agonists, progestins, danazol, aromatase inhibitors
- Surgical intervention - conservative (retain uterus and ovaries) or definitive (TAH-BSO)
Disposition
- Discharge with OB/Gyn follow-up