Pelvic Pain Flashcards
Endometriosis
- Painful chronic disease characterized by the growth of endometrial lesions outside of the endometrail cavity of the uterus
Endometriosis can involve what organs?
- Ovaries
- Fallopian tubes
- Myometrium (uterus)
- Peritoneum
- Bladder
- Bowel
Adenomyosis
- When endometrial glands are present within the muscle (myometrium) of the uterus
Endometriosis disease characteristics
- Progressive disease; can go into remission
- Involves peritoneal implants, fibrosis, adhesions, and formation of endometriomas
- Results in pelvic pain, dyspareunia, dysmenorrhea, infertility, emotional distress and depression
- Most common in teens and 20’s
Chronic Pelvic Pain
- 70% of women who complain of CPP will have some degree of endometriosis
- The remaining women will have issues w/ GI, GU, musculo-skeletal or myofascial pain syndromes
Endometriosis Symptoms
- Tend to be most severe around menstruation
- Some tend to be at ovulation
- Severity does not always correlate w/ the extent of disease
Endometriosis Management
Medical
- OC’s
- NSAIDs
- Levonorgestral containing IUDs
- GnRH agonists
Surgery
- Excision
- Ablation
Endometriosis Staging
- Endometriosis staging and pain are unrelated (can actually be indirect)
- Used to use Stage I-IV, now use minimal, mild, moderate and severe
- Stage I (minimal); milde implants
- Stage II (milde); thicker tissue that has bled and are a little longer, might also have adhesions of the ovary stuck to the pelvic side wall
- Stage III (moderate); start to see nodules and maybe endometriomas
- Stage IV (severe); significant adhesions of the ovary and a lot of times the cul-de-sac is obliterated- the rectum is stuck to the back of the uterus
Endometriosis Types of lesion and pain
- Clear tend to be the most active and assoc. w/ the most pain (76%)
- Red (84%)
- White (44%)
- Black (22%)
Causes of endometriotic pain
- Location of lesion
- Depth of invasion
- Inflammation
- Stretching/ scarring of tissue
Endometriosis Pre-op Prep
- Operate in proliferative phase or suppress ovaries
- Preoperative US to identify endometriomas
- Bowel prep; if theres endometriomas or thickening of tissues in the anticipation that there is bowel involvement
- Consent for possible laparotomy
Laparoscopic Uterine Suspension
- For retroverted uterus with endometriosis
*uterus gets caught up in the adhesions
- Process of raising the uterus out of the pelvis
Endometriosis Post-op medical therapies
- Estrogen/ progestin HC either cyclic or continuous
- LNG-IUD
- Progestins (DMPA or norethindrone acetate)
- GnRH agonists (eg. Lupron, nafarelin spray, danazol)
Adjuvant thereapy was proven to be more beneficial in conjuction w/ surgery
Laparoscopic Endometriosis Ablation
- Destroying of endometrial cells using lasers, electrosurgery or thermal
Endometriosis Treatment options
Surgery is cytoreductive rather than curative. Both methods are effective:
- Excision
- Ablation
Postoperative medical therapy recommended for pelvic pain patients w/ endometriois regardless of “stage” (adjuvant therapy using either GnRH agonist or hormonal contraception)
