Endometriosis

  • Population: women 25-35, 5% to 10% of all women
  • pathogenesis: endometrial tissue outside the uterus (eg, ovaries, fallopian tubes, cul-de-sac, uterosacral ligaments).
  • Symptoms: dysmenorrhea, chronic pelvic pain, deep dyspareunia, dyschezia, and infertility.
  • Physical exam: pelvic exam shows immobile uterus, pain on lateral movement of the cervix; a fixed, uterosacral nodularity, and adnexal masses, although examination is often normal.
  • treatment:
    • does not need biopsy to confirm diagnosis before starting treatment
    • 1st line: NSAIDS, combined OCP (decrease pain/inflammation)
    • progestin only: medroxyprogesterone acetate
    • GnRH analogs (leuprolide)
    • synthetic androgen (danazol)
    • surgical excision
    • hysterectomy and salpingo-oophorectomy