We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Endometriosis
From WikEM
Contents
Background
- Endometrial glands and stroma at extrauterine sites, generally in the pelvis but can be anywhere in the body
- The condition is a common, benign, estrogen-dependent disorder
- Can be associated with debilitating symptoms
Clinical Features
- Classic symptoms: dysmenorrhea, pelvic pain, dyspareunia, and infertility
- Other symptoms may include: include abnormal uterine bleeding, low back pain, or chronic fatigue
- Endometriosis is commonly detected as an asymptomatic incidental finding on pelvic ultrasound or during a surgical procedure
Differential Diagnosis
- Ectopic pregnancy
- Pelvic inflammatory disease
- Interstitial cystitis
- Adenomyosis
- Ovarian neoplasms
- Pelvic adhesions
- Irritable bowel syndrome
- Colon cancer
- Diverticular disease
Nonpregnant Vaginal Bleeding
Systemic Causes
- Cirrhosis
- Coagulopathy (Von Willebrand, ITP)
- Group A strep vaginitis (prepubertal girls)
- Hormone replacement therapy
- Hypothyroidism
- Secondary anovulation
Reproductive Tract Causes
- Adenomyosis
- Atrophic endometrium
- Dysfunctional uterine bleeding
- Endometriosis
- Fibroids
- Foreign Body
- Infection (vaginitis, PID)
- IUD
- Neoplasia
- Vaginal Trauma
Evaluation
- History of symptoms described above
- Exam with tenderness when palpating posterior fornix
- Labs are not generally useful
- Pelvic ultrasound is the first-line study
- Laparoscopy for definitive diagnosis
Management
- Expectant management
- Analgesia
- Hormonal medical therapy
- OCP's, GnRH agonists, progestins, danazol, aromatase inhibitors
- Surgical intervention - conservative (retain uterus and ovaries) or definitive (TAH-BSO)
Disposition
Referral to gynecology
