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