Endometriosis, from Johns Hopkins' Manual of GYN & OB

Definition
1. presence of endometrial gland & storma in extrauterine site

Epidemiology
1. uncertain
2. Consider endometriosis in chronic pelvic pain & in dysmenorrhea

Etiology
1. Transport
== retrograde menstruation (via fallopian tube to peritoneum)
== Others (hematogenous, lymphatic, iatrogenic)
2. Coelomic metaplasia
3. Genetic (1 relative have, 7-fold risk)
4. Immunologic (change of peritoneal macrophage cytotoxicity )

Diagnosis
== By HISTOLOGY (endometrial gland and storma, hemosiderin-laden
macrophage)

Clinical manifestation
1. pelvic pain
2. Dysmenorrhea (during MC)
3. Dyspareunia
4. infertility

== Others:
1. nodularity in uterosacral ligment, tender adnexa, painful swelling
Coul-de-sac
2. appearance:
== blue-black powerder-burn
== red? (more active status)
== chocolate cyst
3. Image: by Sono
4. Lab: Ca-125, Ca19-9 (more specific)

Tx (target: pain, fertility)
1. LHRH agonist (Leuprolide, Nafarelin, Goserelin)
-- side effect: bone, lipid profile
-- Tx course does not exceed 6 month
-- Consider Estrogen + Progestin supplement if Tx > 6 mths

2. OC
-- inhibit ovulation
-- may potentiate endometriosis due to component of estrogen

3. Progestins
-- decidualization and anovulation
-- be awqre of bone effect

4. Danazol
-- 17 alpha-ethinyltestosterone
-- artificial
mechanism
(1)inhibit mid cycle of Lh -> inhibit anovulation
(2)inhibit steriogenesis in corpus leutium
-> high testosterone, low estrogen -> control endometriosis
adverse effect
(1)cholesterol, fluid retention: be aware in CHF, HTN, CRI patient
(2)metabolized by liver: be aware in liver dysfunction patient

Surgical intervention
== (*)excision of endometriosis, lysis of adhesion
== conservative or definitive

Conservative = (*) + neurectomy
== not indicated for those who had the desire of pregnancy
== medication should not be used after conservative Tx, or become
infertility
Definitive = (*) + hysterectomy + bil salpingo-oophorectomy