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Endometriosis
OVERVIEW: Endometriosis is a disorder of the uterus that leads to painful menstruation, infertility, and other conditions. It is caused by the misplacement of uterine lining tissue outside the uterus, such as on the ovaries or in the fallopian tubes. Endometriosis can also affect distant sites throughout the abdomen and chest.
SIGNS AND SYMPTOMS: • Infertility
• Painful intercourse
• Menstrual cramps
• Difficulty with defecation
• Chronic pelvic pain
• Premenstrual spotting
• Miscarriage
CAUSES: • Unknown
SCOPE: Endometriosis affects 8-30% of women of childbearing age.
MOST OFTEN AFFECTED: Women of reproductive age
RISK FACTORS: • Hereditary/genetic predisposition
• Personality traits (achieving, egocentric, overanxious, perfectionist, intelligent, underweight; however, the validity of these observations lacking)
• Delayed childbearing
• Hormonal disturbance (luteinized unruptured follicle syndrome)
DIAGNOSIS PHYSICAL EXAMINATION: • Thorough to identify and rule out other potential causes of pelvic pain including complications of pregnancy, urinary tract infection, irritable bowel syndrome, ulcerative colitis, Crohn's disease, ruptured ovarian cyst, and other conditions.
• The Physician will look for other conditions known to be associated with endometriosis.
TESTS AND PROCEDURES: • Blood tests, urinalysis
• Ultrasound or magnetic resonance imaging (MRI) may be done to assess the pelvic structures.
• The reproductive tract may be visually examined by laparoscopy.
• A sample of uterine tissue may be obtained by biopsy for laboratory analysis.
TREATMENT GENERAL MEASURES: • Endometriosis should be diagnosed and treated early to prevent infertility and pelvic pain.
• Prevention of disease is difficult; however, disease may be managed with oral contraceptive agents.
• Treatment of endometriosis may require hospitalization.
• Surgery may be required.
ACTIVITY: Activity may be limited depending upon severity of pelvic pain.
DIET: No special diet
MEDICATIONS COMMONLY PRESCRIBED DRUGS: • Nafarelin (Synarel), leuprolide acetate (Lupron, Depo-Lupron), goserelin (Zoladex)
• Maintenance: oral contraceptives, calcium supplements
CONTRAINDICATIONS: Any contraindication to the drug itself or low estrogen levels.
PRECAUTIONS: • Drugs may cause calcium loss, hot flashes, tingling sensation of face and arms.
• Contraception should be used by sexually active women.
DRUG INTERACTIONS: Refer to manufacturer's literature.
Other Drugs: • Danazol(Danocrine)
• Medroxyprogesterone (Provera)
• Megestrol (Megace)
• Continuous oral contraceptives, e.g., norgestrel-ethinyl estradiol (Lo/Ovral, Ovral) until childbearing is desired
FOLLOW UP PATIENT MONITORING: • The Physician should be seen every 8-12 weeks.
• Ultrasound should be done every 8-12 weeks.
• Additional surgery may be needed.
PREVENTION/AVOIDANCE: • Pregnancy seems to temporarily improve the disease.
• Endometriosis is generally a recurring disorder that may persist even into early menopause.
COMPLICATIONS: • Nafarelin (Synarel), leuprolide acetate (Lupron, Depo-Lupron), goserelin (Zoladex)
• Maintenance: oral contraceptives, calcium supplements
WHAT TO EXPECT: • Pregnancy can occur, but depends upon the severity of the disease.
• Disease gradually improves with the onset of menopause, but can usually be controlled during the reproductive years.
MISCELLANEOUS OTHER FACTORS: N/A
PEDIATRIC: N/A
GERIATRIC: Endometriosis can persist during early menopause and may be worsened with estrogen replacement therapy (ERT).
OTHERS: N/A
PREGNANCY: See a board certified reproductive endocrinologist or gynecologist with expertise in infertility.
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