endometriosis & adenomyosis ob & gyn hospital, fudan university lei yuan, md [email protected]
TRANSCRIPT
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
