endometriosis & adenomyosis ob & gyn hospital, fudan university lei yuan, md ylronda@163.com

Endometriosis & Adenomyosis

OB & GYN Hospital, Fudan UniversityLei Yuan , MD

ylronda@163.com

Endometriosis

Endo Endometrium

Adenomyosis

Adeno Adeno(ids)

- OSIS

Key points

• Symptoms

• Diagnosis

• Treatment

Endometriosis & Adenomyosis

Case discussion

• Diagnosis

• Differential diagnosis

• Further examination

• Treatment

Endometriosis Symptoms: pains secondary dysmenorrhea;

(Non Specific) dyspareunia;

progressive;

Infertility

Diagnosis:

– Gold standard——visual inspection of the pelvis via laparoscopy

– Histological confirmation——ideally ， negative one does not exclude diagnosis

Basics

Key points Endometriosis

Basics

Treatment: Individualized and standardized

Key points

Characteristic of disease

Patient’s condition

Surgery

• Laparoscopy or laparotomy

• Radical or conservative

Non-surgical treatment

(medication)

• First-line medication• Progestins• Gonadotropin-releasing

hormone (GnRH) agonists

• Danazol (androgenic)• Oral contraceptives • Controlled ovarian

hyperstimulation (fertility treatment)

Text

Endometriosis

Adenomyosis Symptoms: Typical:

Pain secondary dysmenorrhea

progressive / severe

Menorrhagia

symptomless: 35 ％ 15% associated with EMs Signs:

Symmetrically enlarged uterus

Boggy and tender( softer than myoma)

Basics

Key points Adenomyosis

Diagnosis:− Symptoms, Signs,− Ultrasonography − Pathology

Basics

Key points Adenomyosis

Treatment:– Principles: patients’ age; severity of symptoms;

fertility requirements– Medication: symptom relieved, none radical cure

NASIDs; Ocs;

Mirena( a low-dose hormonal IUD)

− Surgery: no fertility desire;

no respond to medical treatment

Hysterectomy

(ovary preservation as appropriate)

www.themegallery.com

Case discussion

CASE 1

Case 1

History: 33-year-old female, pelvic pain during menstruation for 4

years, progressively worse over the years, with pre and postmenstrual spotting; dyspareunia and pain during defecation for 6 months, progressively worse ; no change in the color or caliber of her stool; no sexually active besides her husband; no birth control, and been trying to get pregnant for the last 3.5 years.

Menstrual history: regular G0P0 Normal Pap smear 6 months ago.

Case discussion

Case 1

Pelvic examination – Uterus: fixed, retroverted. – Tender nodularity of the uterosacral ligaments bilaterally.– Both ovaries are somewhat tender and mildly enlarged.

Case discussion

Initial diagnosis: Pelvic inflammation PCOS Endometriosis Ovarian cancer hydrosalpinx

Next step?

Ultrasonography ：

1)bilateral adnexal masses;2)a thick, viscous dark brown fluid

CA125 ： 87 U/ML

PCOS Endometriosis 　

What is your answer?

Management PrincipleThe certainty of the diagnosisThe severity of symptomsThe extent of the diseaseThe desire for future fertilityThe age of the patients

Surgical treatment Laparoscopy Cystectomy Hydrotubation

Laparoscopic assisted cystectomy

Puncture sites UmbilicusMcBurney's point reverse McBurney‘s pointsuprapubic ventral midline

Video

From Novak Gynecology 14 th

Histologic features

Post-operative medication

Status quo: Still controversialObjectives: to reduce recurrence and

promote fertilityMedication: GnRHa, Progestin, OCs …

www.themegallery.com

QUESTIONS

Symptoms

Signs

EMs Types:

Staging

Management

CASE 2

Case 2

History 41-year-old female, increasing colicky pain during

menstruation which needs ibuprofen to relieve symptom; her volume of menstrual flow has increased steadily over the last several months, though her cycles continue to be regular; no vaginal discharge or fever.

Menstrual history: regular G1P1 Normal Pap smear 2 months ago Dilation and curettage 2 months ago

Case discussion

Case 2

Pelvic examination – Uterus: symmetrically enlarged, smooth with a boggy

consistency that is somewhat tender. – No adnexal masses are appreciated.

Laboratory Findings – Hemoglobin: 11g/dL

Case discussion

Questions

Current diagnosis

Differential diagnosis

Further examination

Treatment

Case discussion Case 2

Questions

Current diagnosis Adenomyosis?

Differential diagnosis Uterine myoma Dysfunctional uterine bleeding (DUB) Endometriosis

Further examination Radiologic imaging Ultrasound

Treatment Medication OR surgery

Case discussion Case 2

Take home message

1. Familiarize with the causes and pathogenesis of endometriosis

2. Master the clinical features, diagnosis and differential diagnosis of endometriosis

3. Grasp the major principles behind the treatment strategy of endometriosis