Endometriosis

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

Differential Diagnosis

Nonpregnant Vaginal Bleeding

Systemic Causes

  • Cirrhosis
  • Coagulopathy (Von Willebrand, ITP)
  • Group A strep vaginitis (prepubertal girls)
  • Hormone replacement therapy
  • Hypothyroidism
  • Secondary anovulation

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