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
*Other symptoms may include: include abnormal uterine bleeding, low back pain, or chronic fatigue
*Mnemonic: 3 D's--dysmenorrhea, dyschezia and dyspareunia
*Other symptoms may include: include abnormal [[vaginal Bleed 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
*[[Catamenial pneumothorax]]- rare complication involving recurrent spontaneous pneumothoraces occurring around menses


==Differential Diagnosis==
==Differential Diagnosis==
*Ectopic pregnancy
*[[Ectopic pregnancy]]
*Pelvic inflammatory disease
*[[Pelvic inflammatory disease]]
*Interstitial cystitis
*[[Interstitial cystitis]]
*Adenomyosis
*[[Adenomyosis]]
*Ovarian neoplasms
*Ovarian neoplasms
*Pelvic adhesions
*Pelvic adhesions
*Irritable bowel syndrome
*[[Irritable bowel syndrome]]
*Colon cancer
*[[Colon cancer]]
*Diverticular disease
*[[Diverticulitis|Diverticular disease]]


==Diagnosis==
{{VB DDX nonpregnant}}
 
==Evaluation==
*History of symptoms described above
*History of symptoms described above
*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==
*Expectant 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
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==Disposition==
==Disposition==
Referral to gynecology
*Discharge with OB/Gyn follow-up


==See Also==
==See Also==
*[[Pelvic Pain]]


==External Links==
==External Links==


==References==
==References==
<UpToDate>
<references/>


[[Category:OB/GYN]]
[[Category:OBGYN]]

Revision as of 15:01, 12 October 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
  • Catamenial pneumothorax- rare complication involving recurrent spontaneous pneumothoraces occurring around menses

Differential Diagnosis

Nonpregnant Vaginal Bleeding

Systemic Causes

Reproductive Tract Causes

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

See Also

External Links

References