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Questions and Answers
What is a possible treatment option for adenomyosis?
What is a possible treatment option for adenomyosis?
What is the term used for endometriosis lesions that appear as small, black dots?
What is the term used for endometriosis lesions that appear as small, black dots?
Which factor is NOT typically associated with an increased risk of endometriosis?
Which factor is NOT typically associated with an increased risk of endometriosis?
What is the primary difference between adenomyosis and endometriosis?
What is the primary difference between adenomyosis and endometriosis?
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Which of these is NOT a possible symptom of endometriosis?
Which of these is NOT a possible symptom of endometriosis?
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What is the most likely reason for the increasing awareness and recognition of endometriosis?
What is the most likely reason for the increasing awareness and recognition of endometriosis?
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Which of the following is NOT a possible microscopic finding in endometriosis?
Which of the following is NOT a possible microscopic finding in endometriosis?
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What is the term used to describe endometriosis lesions that appear as large, fluid-filled cysts?
What is the term used to describe endometriosis lesions that appear as large, fluid-filled cysts?
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What is the gold standard investigation for diagnosing endometriosis?
What is the gold standard investigation for diagnosing endometriosis?
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What is the most reliable time to perform a clinical examination for detecting deeply infiltrating endometriosis nodules?
What is the most reliable time to perform a clinical examination for detecting deeply infiltrating endometriosis nodules?
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Which of the following statements is TRUE about the role of histology in diagnosing endometriosis?
Which of the following statements is TRUE about the role of histology in diagnosing endometriosis?
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What is the role of CA 125 blood test in diagnosing endometriosis?
What is the role of CA 125 blood test in diagnosing endometriosis?
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Which of the following is NOT a mechanism by which endometriosis can lead to infertility?
Which of the following is NOT a mechanism by which endometriosis can lead to infertility?
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Which of the following medical treatments for endometriosis uses the principle of pseudopregnancy?
Which of the following medical treatments for endometriosis uses the principle of pseudopregnancy?
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Danazol, a medical treatment for endometriosis, works by:
Danazol, a medical treatment for endometriosis, works by:
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Which of the following is NOT a potential side effect of Danazol treatment?
Which of the following is NOT a potential side effect of Danazol treatment?
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Which of the following is a medical treatment option for endometriosis-associated pain?
Which of the following is a medical treatment option for endometriosis-associated pain?
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Regarding the effectiveness of surgical treatment for endometriosis-associated infertility, which statement is accurate?
Regarding the effectiveness of surgical treatment for endometriosis-associated infertility, which statement is accurate?
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Which of the following is NOT a reason to consider IVF as an appropriate treatment for endometriosis-associated infertility?
Which of the following is NOT a reason to consider IVF as an appropriate treatment for endometriosis-associated infertility?
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What does the text suggest about the use of GnRH agonists prior to IVF for endometriosis-associated infertility?
What does the text suggest about the use of GnRH agonists prior to IVF for endometriosis-associated infertility?
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Which of the following is a common side effect associated with Gestrinone?
Which of the following is a common side effect associated with Gestrinone?
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What is the primary mechanism of action of Aromatase Inhibitors in the treatment of endometriosis?
What is the primary mechanism of action of Aromatase Inhibitors in the treatment of endometriosis?
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Which of the following surgical approaches for endometriosis is considered conservative?
Which of the following surgical approaches for endometriosis is considered conservative?
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Which of the following statements on the effectiveness of medical treatment for endometriosis-associated pain is accurate?
Which of the following statements on the effectiveness of medical treatment for endometriosis-associated pain is accurate?
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Flashcards
Endometriosis Diagnosis
Endometriosis Diagnosis
The diagnosis of endometriosis is confirmed via laparoscopy and histology, often assessed during menstruation for best results.
Laparoscopy
Laparoscopy
A minimally invasive surgical procedure considered the gold standard for diagnosing endometriosis.
Histological Confirmation
Histological Confirmation
Confirmation of endometriosis requires at least one positive histological lesion; negative results do not exclude the disease.
Endometriosis and Infertility
Endometriosis and Infertility
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Medical Treatment of Endometriosis
Medical Treatment of Endometriosis
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Danazol
Danazol
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Danazol Side Effects
Danazol Side Effects
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Combined Pills
Combined Pills
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Endometriosis
Endometriosis
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Adenomyosis
Adenomyosis
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Causes of Adenomyosis
Causes of Adenomyosis
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Endometriosis Predisposing Factors
Endometriosis Predisposing Factors
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Endometriosis Pathology - Macroscopic
Endometriosis Pathology - Macroscopic
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Symptoms of Endometriosis
Symptoms of Endometriosis
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Adenomyosis vs Myoma
Adenomyosis vs Myoma
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Clinical Presentation of Endometriosis
Clinical Presentation of Endometriosis
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Gesrinone
Gesrinone
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Aromatase Inhibitors
Aromatase Inhibitors
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GnRH Agonists
GnRH Agonists
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Surgical Rx for Endometriosis
Surgical Rx for Endometriosis
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NSAIDs Effectiveness
NSAIDs Effectiveness
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Assisted Reproduction in Endometriosis
Assisted Reproduction in Endometriosis
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Postop hormonal treatment
Postop hormonal treatment
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Endometriosis Pain Management
Endometriosis Pain Management
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Study Notes
Endometriosis
- Endometriosis is the presence of tissue similar to normal endometrium, in structure and function, outside the uterine cavity.
- Adenomyosis is a type of endometriosis where endometrial tissue grows within the uterine muscle wall.
- True Endometriosis differs from Adenomyosis in location, affecting tissues beyond the uterine wall.
Adenomyosis
- Etiology of adenomyosis includes repeated pregnancies, vigorous curettage, and hormonal imbalance.
- Pathological characteristics include symmetrical uterine enlargement, which may be localized or diffuse. The uterine tissue displays endometrial glands and stroma surrounded by muscle fibers.
- Clinical characteristics include: end of reproductive life, multiparous, asymptomatic, menorrhagia (excessive bleeding during menstruation, possibly due to uterine enlargement and increased blood supply), and impaired uterine contractility. Dysmenorrhea (painful menstruation) and dyspareunia (painful sexual intercourse) are also possible.
- Myomas (uterine fibroids) differ from adenomyosis as fibroids seldom enlarge the uterus to over 12-14 weeks gestation.
- Treatment can include Total Abdominal Hysterectomy (TAH).
Endometriosis--Pathology
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Macroscopic findings include: small black dots ("powder burn"), large cystic masses ("chocolate cysts"), diverse lesions including black, dark-brown, bluish-puckered lesions and nodules. Atypical lesions are also present, including red implants (petechial, vesicular, polypoid), red-flame-like implants, and serous or clear vesicles. White plaques and scarring may also be present.
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Microscopic examination reveals endometrial glands and stroma, with evidence of bleeding.
Endometriosis-Diagnosis
- Symptomatology: is an initial diagnostic guide.
- Definitive diagnosis: is obtained by laparoscopy and histology (tissue examination).
- Laparoscopy, while providing high diagnostic specificity and sensitivity, requires accurate timing in the menstrual cycle to ensure sufficient evidence and can vary in interpretation when used in conjunction with classification systems (which can be subjective and poorly correlated with the pain symptoms).
- CA 125 levels may be elevated (but not considered a reliable diagnostic tool).
Endometriosis-Histology
- Determining the necessity of histology can be controversial. A positive histology confirms the presence, but negative histology alone does not exclude the possibility.
- Ideally, histological confirmation of at least one lesion is necessary, especially for endometriomas larger than 3 cm or for deep infiltrating disease needing further histology.
Endometriosis & Infertility
- Endometriosis presence correlates with infertility rates (15% of infertile women and 40-60% of affected individuals).
- Mechanisms of infertility associated with endometriosis include adhesions, reduced tubal motility, disturbed folliculogenesis and corpus luteum function, and increased inflammatory macrophages. Dyspareunia (painful sex), and increased prostaglandins also are present.
Endometriosis - Treatment
- Treatment decisions depend on severity of symptoms, patient age, and fertility expectations.
- Types of treatment include expectant management, surgical interventions (radical and conservative), and medical interventions.
Endometriosis-Medical Rx
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Medical treatment for endometriosis often involves drugs inducing remission during pregnancy (pseudopregnancy) and those inducing remission after menopause (pseudomenopause), as these periods often induce remission, often due to hormone changes.
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Hormone-based therapies (androgens, combined pills, progestins, danazol, gestrinone, GnRH agonists, and aromatase inhibitors) are often prescribed to manage endometriosis.
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Danazol: a synthetic androgen, acts by binding to sex hormone-binding globulin (SHBG), increasing free testosterone. It also prevents the monthly surge of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), inhibiting ovarian steroidogenesis (estrogen and androgen production). However, it's associated with various side effects, such as weight gain, fluid retention, breast reduction, facial hair growth, emotional lability, fatigue, oily skin, atrophic vagina, muscle cramps, deepening voice, increased cholesterol and decreased HDL. It is usually administered for 6 to 9 months at a dose of 200 mg twice daily, but has specific contraindications, such as pregnancy, severe hepatic, cardiac or renal diseases, thromboembolism, porphyria, and androgen-dependent tumours.
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Gestrinone: is a trienic-19-norsteroid inhibiting the mid-cycle surge of FSH and LH, having similar side effects as danazol but with a longer half-life (longer duration of effect, requiring a lower frequency of administration). Its typical dosage is between 2.5 and 5 mg twice weekly.
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GnRH agonists: These cause menopausal symptoms, breakthrough bleeding, and bone loss.
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Aromatase inhibitors: (e.g., anastrozole, letrozole) work to decrease both peripheral and local estradiol production. This may be a better choice than GnRH agonists for reducing estrogen-driven endometriosis, often administered with ovarian suppression.
Endometriosis--Surgical Rx
- Radical treatment involves a total abdominal hysterectomy (TAH) and removal of as much endometriosis as feasible, along with bilateral oophorectomy (removal of the ovaries).
- Conservative treatment approaches include dividing adhesions, conducting tuboplasty (reconstructing fallopian tubes), presacral neurectomy (nerve ablation near the sacrum), and laser uterine nerve ablation.
Endometriosis--Pain
- Management of pain associated with endometriosis may involve empirical treatment (without definite diagnosis, using appropriate analgesics, progestins, and combined oral contraceptives) prior to definitive diagnosis.
- Effectiveness of NSAIDS is inconsistent.
- Suppressing ovarian function for six months sometimes reduces pain, but symptom recurrence is common. Some studies show aromatase inhibitors may be effective. LNG-IUS (levonorgestrel-releasing intrauterine system) is also used for reducing pain.
Endometriosis--Assisted Reproduction
- IUI (Intrauterine Insemination) may improve fertility in cases of minimal/mild endometriosis.
- In severe cases, IVF (in-vitro fertilization) is often a primary choice, especially if other treatment options haven't worked or tubal function, male factor or other fertility-related concerns exist. GnRH agonists administered for 3-6 months prior to IVF may increase the likelihood of a successful clinical pregnancy in these cases.
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Description
Test your knowledge on endometriosis and adenomyosis, including their definitions, characteristics, and clinical implications. This quiz explores the differences between these two conditions and their impact on women's health. Perfect for students and healthcare professionals alike.
