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Endometriosis & Adenomyosis

Endometriosis & Adenomyosis. OB & GYN Hospital, Fudan University Lei Yuan , MD ylronda@163.com. Endometriosis Endo Endometrium. Adenomyosis Adeno Adeno (ids). - OSIS. Endometriosis & Adenomyosis. Key points Symptoms Diagnosis Treatment. Case discussion Diagnosis

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Endometriosis & Adenomyosis

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  1. Endometriosis & Adenomyosis OB & GYN Hospital, Fudan University Lei Yuan , MD ylronda@163.com

  2. Endometriosis • Endo • Endometrium • Adenomyosis • Adeno • Adeno(ids) - OSIS

  3. Endometriosis & Adenomyosis • Key points • Symptoms • Diagnosis • Treatment • Case discussion • Diagnosis • Differential diagnosis • Further examination • Treatment

  4. Key points Endometriosis Basics • 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

  5. Key points Endometriosis Text • 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) Characteristic of disease Patient’s condition Basics • Treatment: Individualized and standardized

  6. Key points Adenomyosis Basics • 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)

  7. Key points Adenomyosis Basics • Diagnosis: • Symptoms, Signs, • Ultrasonography • Pathology

  8. 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)

  9. Case discussion

  10. Case 1

  11. Case discussion 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.

  12. Case discussion Case 1 Pelvic examination • Uterus: fixed, retroverted. • Tender nodularity of the uterosacral ligaments bilaterally. • Both ovaries are somewhat tender and mildly enlarged.

  13. Next step? Initial diagnosis: • Pelvic inflammation • PCOS • Endometriosis • Ovarian cancer • hydrosalpinx

  14. Ultrasonography：1)bilateral adnexal masses;2)a thick, viscous dark brown fluid CA125：87 U/ML

  15. PCOS Endometriosis What is your answer?

  16. Management • Principle • The certainty of the diagnosis • The severity of symptoms • The extent of the disease • The desire for future fertility • The age of the patients

  17. Surgical treatment • Laparoscopy • Cystectomy • Hydrotubation

  18. Laparoscopic assisted cystectomy • Puncture sites • Umbilicus • McBurney's point • reverse McBurney‘s point • suprapubic ventral midline

  19. Video

  20. From Novak Gynecology 14 th

  21. Histologic features

  22. Post-operative medication Status quo: Still controversial Objectives: to reduce recurrence and promote fertility Medication: GnRHa, Progestin, OCs …

  23. QUESTIONS Symptoms Signs EMs Types: Staging Management

  24. Case 2

  25. Case discussion 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

  26. 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

  27. Case discussion Case 2 Questions • Current diagnosis • Differential diagnosis • Further examination • Treatment

  28. 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

  29. 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

  30. Thank You !

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