A 23-year-old woman regularly has episodes of pain associated with menstrual periods. Following investigations, you diagnose endometriosis.
Which one of the following is the commonest site of this disease outside of the pelvis?
Correct Answer A:
In endometriosis, small or large patches of endometrial tissue, which are usually located only in the lining of the uterus (endometrium), appear in other parts of the body. How and why the tissue appears in other locations is unclear. When this happens it causes dysmenorrhea, dyspareunia and infertility.
The most common locations include the ovaries, fallopian tubes, and ligaments supporting the uterus. But the misplaced tissue may also appear in other locations in the pelvis and abdomen. Common locations of misplaced endometrial tissue (called implants) include the ovaries, the ligaments that support the uterus, the space between the rectum and vagina or cervix, and the fallopian tubes. Less common locations include the outer surface of the small and large intestines, the ureters (tubes leading from the kidneys to the bladder), the bladder, and the vagina.
A 37-year-old woman has severe pain during menses which radiates into the anal region. On bimanual exam, she has a small, retroverted uterus and tender nodules can be felt on palpation of the uterosacral ligaments.
Which of the following conditions does she most likely have?
Correct Answer D:
Endometriosis is a condition in which bits of tissue from the lining of the uterus (endometrium) grow outside the uterus. The endometrial tissue, called an endometrial implant, usually adheres to the pelvic organs, which include the ovaries, uterus, fallopian tubes, the cavity behind the uterus, and the ligaments that support the uterus. Endometrial implants may also adhere to the tubes leading from the kidneys to the bladder, the bladder, the vagina, the outer surface of the small and large intestine, or the lining of the chest cavity.
Endometriosis progresses slowly. So, a woman may have the disease but not experience any symptoms for years. There is no link between the severity of the symptoms and the severity of the disease. Some women have great pain, but very few endometrial implants. The most common symptoms include pain in the lower abdomen during the menstrual period, spotting between periods, heavy or irregular periods, pain during intercourse, pain during bowel movements or urination, and lower back pain. Many women with endometriosis experience infertility because the endometrial implants block the passage of the egg from the ovary to the uterus.
Diagnoses is aided by a pelvic exam to feel for endometrial implants. The best way to diagnosis this disease, however, is through a procedure called laparoscopy.
In endometriosis, the most common location for disease is:
Correct Answer C:
Endometriosis is a condition in which bits of tissue from the lining of the uterus (endometrium) grow outside the uterus. The endometrial tissue, called an endometrial implant, usually adheres to the pelvic organs, which include the ovaries (most common), uterus, fallopian tubes, the cavity behind the uterus, and the ligaments that support the uterus. Endometrial implants may also adhere to the tubes leading from the kidneys to the bladder, the bladder, the vagina, the outer surface of the small and large intestine, or the lining of the chest cavity. These locations, however, are not as common.
Which of the following statements regarding endometriosis is incorrect?
Correct Answer B:
Measurement of the serum concentration of the CA-125 glycoprotein antigen is the most widely studied biochemical method of screening for ovarian cancer. Serum CA 125 values are elevated in approximately 50 percent of women with early stage disease and in over 80 percent of women with advanced ovarian cancer. However, the specificity of CA 125 is limited. CA-125 is also increased in a variety of benign and malignant conditions, including endometriosis, but it's not useful in diagnosing it.
A 34-year-old white female visits your office with a chief complaint of pelvic pain that intensifies with her menstrual period. She has a history of pain during intercourse, which started in her mid-twenties and has gradually become worse.
She reports recently missing some work during her menstrual period due to the pain. She has had two uneventful deliveries and the pain was absent during and after each pregnancy, but gradually returned. She and her husband do not wish to have any more children and her husband has had a vasectomy.
The patient denies vaginal discharge or fever and a review of systems is negative. A complete physical examination is normal except for moderate non-specific tenderness on pelvic examination. In addition, her uterus is moderately retroverted and has decreased mobility.
Which one of the following would be the most appropriate initial step in the management of this patient?
This patient has endometriosis. Combination oral contraceptives should be first-line therapy for women with endometriosis who do not wish to become pregnant. Conjugated estrogens is not a treatment for endometriosis. Depot medroxyprogesterone acetate and danazol are accepted treatments, but each has undesirable side effects. A complete hysterectomy and bilateral oophorectomy is considered a radical surgical approach, and is reserved for more difficult endometriosis cases.
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