Endometriosis for PA
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Endometriosis for the Physician Assistant Licensing Exam
Definition and Pathophysiology
- Definition
- Endometriosis is a chronic, estrogen-dependent disorder where endometrial-like tissue grows outside the
- Pathophysiology
- Retrograde Menstruation: Menstrual blood flows backward through the fallopian tubes, allowing endometrial cells to implant in the pelvis.
- Estrogen Dependence: Ectopic endometrial tissue responds to hormonal changes, leading to cyclical inflammation, pain, and growth.
Risk Factors
- Family History: Increased incidence among first-degree relatives.
- Early Menarche and Short Menstrual Cycles: Leads to more menstrual cycles over a lifetime.
- Nulliparity: Higher prevalence in women without prior pregnancies.
Clinical Manifestations
- Pelvic Pain:
- Often presents as cyclic pain that worsens during menstruation (dysmenorrhea).
- Chronic pain can occur as the disease progresses.
- Dyspareunia: Painful intercourse, often due to pelvic adhesions.
- Dyschezia: Painful bowel movements, especially around menstruation if bowel is affected.
- Infertility: Common complication due to pelvic adhesions and anatomic distortions.
Diagnosis
- Clinical Assessment:
- Evaluation of symptoms, including pelvic pain, dysmenorrhea, and infertility.
- Physical exam may reveal tenderness or nodularity in the pelvis.
- Imaging:
- Transvaginal Ultrasound: Often first-line for detecting ovarian cysts (endometriomas).
- MRI: Sometimes used to assess deeper lesions.
- Laparoscopy:
- Gold Standard: Direct visualization confirms diagnosis and allows for biopsy if needed.
Management
- NSAIDs: Used for pain relief.
- Hormonal Therapy:
- Combined Oral Contraceptives (COCs): Reduce symptoms by suppressing menstruation.
- Progestins and GnRH Agonists: Induce hypoestrogenic states to minimize lesion growth.
- Surgical Management:
- Laparoscopic Excision or Ablation: For symptom relief and fertility preservation if unresponsive to medical therapy.
Key Points
- Endometriosis is a chronic condition with extrauterine endometrial-like tissue causing pain, infertility, and cyclical symptoms.
- Pathophysiology: Driven by retrograde menstruation and estrogen sensitivity.
- Risk Factors include family history, early menarche, and nulliparity.
- Symptoms: Dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility.
- Diagnosis: Primarily through symptom evaluation and imaging; laparoscopy confirms diagnosis.
- Management: Includes NSAIDs, hormonal therapies (COCs, progestins), and surgical options for refractory cases or fertility concerns.