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Pathophysiology of Endometriosis
Pathophysiology

Pathophysiology of Endometriosis 

Pathophysiology of Endometriosis:

Endometriosis is the presence of endometrial tissue outside of the uterine cavity, most commonly surrounding the ovaries and fallopian tubes.

Diagnosis:

  • Biopsy or laparoscopy
  • Magnetic resonance imaging (MRI)
  • Ultrascopy
  • Pelvic Examination

 

Classification:

  • Minimal – few superficial implants
  • Mild – more and slightly deeper implants
  • Moderate – many deep implants and small tumours on ovaries
  • Severe – many deep implants and large tumours on ovaries

 

Significance:

  • Untreated endometriosis may lead to
  • Infertility
  • Cancer

 

Contraindications:

Pregnancy – oral contraceptives.

 

Check for symptoms:

  • Common symptoms include cyclic midline pain, infertility, inter menstrual bleeding
  • Based on location of implant symptoms vary specifically
  • Large intestine – pain during defecation, diarrhoea / constipation, rectal bleeding during menses
  • Bladder – dysuria, hematuria, pain during urination
  • Ovarian – cyst rupture results in abdominal pain
  • Extra pelvic structures – abdominal pain

 

 

Prescription contains:

Non Steroidal Anti-Inflammatory Drugs

Drugs to suppress ovarian function.

Counseling on side effects:

Combination estrogen/progestin oral contraceptives:

Ethinyl estradiol -Abdominal swelling, breast tenderness, increased appetite, bleeding, deep venous thrombosis

Progestins:

Levonorgestrel – Irregular uterine bleeding, weight gain

Medroxyprogesterone – bleeding, depression, weight gain

Norethindrone acetate – Irregular uterine bleeding, emotional lability, depression, weight gain

Androgens:

Danazol – Weight gain, acne, lowering of the voice, hirsutism, edema, muscle cramps, breakthrough bleeding

GnRH agonists:

Leuprolide – allergic reactions, bone demineralization.

Risk factors:

  • Genetic predisposition
  • Aging
  • environmental toxins(dioxin)                              

 

 

Counseling on diet, exercise, lifestyle management:

  • Adequate rest, regular exercise, low-fat diet, nutritional supplements such as ω3 fatty acids, flax seeds, magnesium, vitamin E, zinc.

 

Conservative surgery:

Conservative surgery is for women who want to get pregnant or experience severe pain and for whom hormonal treatments aren’t working.

The goal of conservative surgery is to remove or destroy endometrial growths without damaging the reproductive organs.

Laparoscopy, a minimally invasive surgery, is used to both visualize and diagnose, endometriosis. It is also used to remove the endometrial tissue.

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